Provider Demographics
NPI:1083497614
Name:MCCARTHY, LISA ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ROSE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ROSE
Other - Last Name:CONNACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:345 RONAN DR
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16613-8626
Mailing Address - Country:US
Mailing Address - Phone:814-631-8312
Mailing Address - Fax:
Practice Address - Street 1:167 ZEMAN DR
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4103
Practice Address - Country:US
Practice Address - Phone:814-472-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064726363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical