Provider Demographics
NPI: | 1134121296 |
---|---|
Name: | MCCABE, MARC NATHAN (RPA-C) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | MARC |
Middle Name: | NATHAN |
Last Name: | MCCABE |
Suffix: | |
Gender: | M |
Credentials: | RPA-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 30 N UNION RD |
Mailing Address - Street 2: | STE 104 |
Mailing Address - City: | WILLIAMSVILLE |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 14221-5367 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 716-565-3990 |
Mailing Address - Fax: | 716-565-3988 |
Practice Address - Street 1: | 30 N UNION RD |
Practice Address - Street 2: | STE 104 |
Practice Address - City: | WILLIAMSVILLE |
Practice Address - State: | NY |
Practice Address - Zip Code: | 14221-5367 |
Practice Address - Country: | US |
Practice Address - Phone: | 716-565-3990 |
Practice Address - Fax: | 716-565-3988 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-02 |
Last Update Date: | 2011-01-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 069671 | 363AS0400X, 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | S90028 | Medicare UPIN |