Provider Demographics
NPI:1649292855
Name:MCCARTHY, KATHLEEN M (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:515 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1700
Mailing Address - Country:US
Mailing Address - Phone:716-828-2775
Mailing Address - Fax:716-828-3473
Practice Address - Street 1:515 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1700
Practice Address - Country:US
Practice Address - Phone:716-828-2775
Practice Address - Fax:716-828-3473
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-12-07
Deactivation Date:
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Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380270363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9512021OtherINDEPENDENT HEALTH
NY040426001221OtherFIDELIS
NY000560107001OtherBLUE CROSS OF WNY
NY00026553102OtherUNIVERA