Provider Demographics
NPI:1700132685
Name:KERR, MACAULAY S (PA)
Entity Type:Individual
Prefix:
First Name:MACAULAY
Middle Name:S
Last Name:KERR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MACAULAY
Other - Middle Name:
Other - Last Name:STEERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:210 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2901
Mailing Address - Country:US
Mailing Address - Phone:914-681-3100
Mailing Address - Fax:914-682-6588
Practice Address - Street 1:210 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2901
Practice Address - Country:US
Practice Address - Phone:914-681-3100
Practice Address - Fax:914-682-6588
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400114985Medicare PIN