MEDICARE: JOHANNA MARIE MCCARTHY NP

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	363LA2200X	Adult Health Nurse Practitioner	F303476	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P019303476	OTHER	NY	BLUE CHOICE
2	000560716001	OTHER	NY	BLUE CROSS WNY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	NP0516	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1609879089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA MARIE MCCARTHY NP

Provider Business Mailing Address
First Line	:	7 BELVEDERE LN
Second Line	:
City	:	BATAVIA
State	:	NY
Zip	:	14020-1715
Country	:	US
Telephone Number	:	585-344-2280
Fax Number	:	585-344-4243

Provider Business Practice Location Address
First Line	:	127 NORTH ST.
Second Line	:
City	:	BATAVIA
State	:	NY
Zip	:	14020
Country	:	US
Telephone Number	:	585-768-4670
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/14/2017

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