Provider Demographics
NPI:1619975695
Name:MCCARTHY, BETHANY ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANNE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ANNE
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:300 STATE ST FL 4
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1427
Mailing Address - Country:US
Mailing Address - Phone:814-877-4577
Mailing Address - Fax:814-455-3001
Practice Address - Street 1:300 STATE ST FL 4
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1427
Practice Address - Country:US
Practice Address - Phone:814-877-4577
Practice Address - Fax:814-455-3001
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003296L363A00000X
OH50001772363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119217 E7CMedicare PIN
P60814Medicare UPIN
PA119217 E7CMedicare PIN
OH60814Medicare UPIN