Provider Demographics
NPI:1508829508
Name:MCCARTHY, ALICE M (PA)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2253
Mailing Address - Country:US
Mailing Address - Phone:978-534-0582
Mailing Address - Fax:978-534-6519
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2253
Practice Address - Country:US
Practice Address - Phone:978-534-0582
Practice Address - Fax:978-534-6519
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP0193Medicare ID - Type Unspecified
R98993Medicare UPIN