Healthcare Provider Details

I. General information

NPI: 1992860449
Provider Name (Legal Business Name): CARRIE A MCMAHON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CARRIE A HUBBARD

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ROOSEVELT AVE
YORK PA
17404-2244
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-356-6250
  • Fax:
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-217-4218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA057558
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002045
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: