Healthcare Provider Details

I. General information

NPI: 1134121296
Provider Name (Legal Business Name): MARC NATHAN MCCABE RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N UNION RD STE 104
WILLIAMSVILLE NY
14221-5367
US

IV. Provider business mailing address

30 N UNION RD STE 104
WILLIAMSVILLE NY
14221-5367
US

V. Phone/Fax

Practice location:
  • Phone: 716-565-3990
  • Fax: 716-565-3988
Mailing address:
  • Phone: 716-565-3990
  • Fax: 716-565-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number069671
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number069671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: