Provider Demographics
NPI:1902221443
Name:MCCARTHY, MAUREEN E (PA-C)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:E
Other - Last Name:SAYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12780 ROACHTON RD # 1
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1350
Mailing Address - Country:US
Mailing Address - Phone:419-872-0777
Mailing Address - Fax:419-872-2369
Practice Address - Street 1:12780 ROACHTON RD # 1
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1350
Practice Address - Country:US
Practice Address - Phone:419-872-0777
Practice Address - Fax:419-872-2369
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003995363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50003995OtherOHIO STATE LICENSE