Provider Demographics
NPI:1366461774
Name:MCCARTHY, PATRICIA M (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 BOYLSTON ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2503
Mailing Address - Country:US
Mailing Address - Phone:617-734-4936
Mailing Address - Fax:617-734-7804
Practice Address - Street 1:830 BOYLSTON ST
Practice Address - Street 2:SUITE 211
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2503
Practice Address - Country:US
Practice Address - Phone:617-734-4936
Practice Address - Fax:617-734-7804
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA142147363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1155OtherBLUE CROSS BLUE SHIELD
MANP1155OtherBLUE CROSS BLUE SHIELD