Provider Demographics
NPI:1770569311
Name:MCCARTHY, SANDRA Q (PA C)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:Q
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:QUINONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3509 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-4105
Mailing Address - Country:US
Mailing Address - Phone:844-570-1767
Mailing Address - Fax:215-707-6676
Practice Address - Street 1:3509 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-4105
Practice Address - Country:US
Practice Address - Phone:844-570-1767
Practice Address - Fax:215-707-6676
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA 050845363A00000X
PAVP 006973V363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherMEDICARE GROUP
PA073631JTQMedicare ID - Type Unspecified
P98945Medicare UPIN