Provider Demographics
NPI:1962502245
Name:MCCARTHY, JEANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HOSPITAL DR FL 3
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6601
Mailing Address - Country:US
Mailing Address - Phone:413-540-5048
Mailing Address - Fax:
Practice Address - Street 1:11 HOSPITAL DR FL 3
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6601
Practice Address - Country:US
Practice Address - Phone:413-540-5048
Practice Address - Fax:413-540-5049
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA1176363A00000X
MA1176363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP37981Medicare UPIN