Provider Demographics
NPI:1609879089
Name:MCCARTHY, JOHANNA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MARIE
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 1:7 BELVEDERE LN
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1715
Mailing Address - Country:US
Mailing Address - Phone:585-344-2280
Mailing Address - Fax:585-344-4243
Practice Address - Street 1:127 NORTH ST.
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020
Practice Address - Country:US
Practice Address - Phone:585-768-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303476363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP019303476OtherBLUE CHOICE
NY000560716001OtherBLUE CROSS WNY
NY02299970Medicaid
NYNP0516OtherPREFERRED CARE
NYP019303476OtherBLUE CHOICE