Provider Demographics
NPI:1407917560
Name:MCGRATH, PATRICK MICHAEL (PAC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:MCGRATH
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 1ST ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962
Mailing Address - Country:US
Mailing Address - Phone:772-770-6912
Mailing Address - Fax:772-770-6917
Practice Address - Street 1:275 18TH STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-562-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1928WMedicare ID - Type Unspecified
S70651Medicare UPIN