Healthcare Provider Details

I. General information

NPI: 1407103179
Provider Name (Legal Business Name): MARIE ELENA MCCARTHY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE ELENA MINER PA-C

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LRMC/VICENZA UNIT 33100
APO AE
09180
US

IV. Provider business mailing address

4860 S PALMER RD
BETHESDA MD
20889-5649
US

V. Phone/Fax

Practice location:
  • Phone: 324-639-5653
  • Fax:
Mailing address:
  • Phone: 301-319-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110004288
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: