Healthcare Provider Details

I. General information

NPI: 1982259024
Provider Name (Legal Business Name): MARGARET ROSE MCKERNAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 PARK SQUARE DR. STE. B
LORAIN OH
44053-4153
US

IV. Provider business mailing address

2000 AUBURN DR. STE. 350
BEACHWOOD OH
44122-4327
US

V. Phone/Fax

Practice location:
  • Phone: 440-984-6499
  • Fax: 234-757-7545
Mailing address:
  • Phone: 440-646-1600
  • Fax: 440-646-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006265RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: