MEDICARE: KATHARINE E MCCARTHY P.A.

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	14247063-1206	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18007A/J400037314	OTHER	NY	MCR PTAN

General Provider Information

NPI Number	:	1932401288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARINE E MCCARTHY P.A.

Provider Business Mailing Address
First Line	:	4024 PRITCHARD PL
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-6962
Country	:	US
Telephone Number	:	585-735-1296
Fax Number	:

Provider Business Practice Location Address
First Line	:	6211 S HIGHLAND DR # 4124
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84121-2125
Country	:	US
Telephone Number	:	585-734-1296
Fax Number	:

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

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	09/25/2025

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