Provider Demographics
NPI:1790742864
Name:MCGRATH, JEREMY J (PA-C)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:J
Last Name:MCGRATH
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3385 DEXTER CT
Mailing Address - Street 2:STE 101
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3471
Mailing Address - Country:US
Mailing Address - Phone:563-359-1646
Mailing Address - Fax:563-344-6703
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:STE 101
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-359-1646
Practice Address - Fax:563-344-6703
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA001395363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP35073Medicare UPIN