MEDICARE: MICHAEL JOSEPH MCCARTHY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	0010-08814	NC

General Provider Information

NPI Number	:	1518421239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH MCCARTHY PA-C

Provider Business Mailing Address
First Line	:	5404 SIRIUS DR UNIT 101
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-8455
Country	:	US
Telephone Number	:	631-512-1359
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 S MCNEIL ST
Second Line	:
City	:	BURGAW
State	:	NC
Zip	:	28425-5015
Country	:	US
Telephone Number	:	910-302-6285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2019
Last Update Date	:	01/30/2019

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