Healthcare Provider Details

I. General information

NPI: 1467086751
Provider Name (Legal Business Name): JAMES ROBERT MCCARTHY CRNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

20 SHAMROCK RD
LUMBERTON NJ
08048-5292
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3601
  • Fax:
Mailing address:
  • Phone: 609-238-2347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN341380L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: