Provider Demographics
NPI:1073572616
Name:CAROTHERS, JONATHAN R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:R
Last Name:CAROTHERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9104 BABCOCK BLVD
Mailing Address - Street 2:SUITE 2120
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5818
Mailing Address - Country:US
Mailing Address - Phone:412-367-0600
Mailing Address - Fax:412-367-7079
Practice Address - Street 1:9104 BABCOCK BLVD
Practice Address - Street 2:SUITE 2120
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5818
Practice Address - Country:US
Practice Address - Phone:412-367-0600
Practice Address - Fax:412-367-7079
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050770363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1443031OtherHIGHMARK BLUE CROSS B.S.
PAP70306Medicare UPIN
PA1443031OtherHIGHMARK BLUE CROSS B.S.