Provider Demographics
NPI:1053487769
Name:MCCARRON, SARAH JEANNE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JEANNE
Last Name:MCCARRON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:JEANNE
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:940 BELMONT ST
Mailing Address - Street 2:PRIMARY CARE CLINIC
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT ST
Practice Address - Street 2:PRIMARY CARE CLINIC
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5596
Practice Address - Country:US
Practice Address - Phone:800-865-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00369363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPA00369OtherLICENSE
RIPA00369OtherLICENSE