MEDICARE: MR. MARC NATHAN MCCABE RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	069671	NY
2	363A00000X	Physician Assistant	069671	NY

General Provider Information

NPI Number	:	1134121296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARC NATHAN MCCABE RPA-C

Provider Business Mailing Address
First Line	:	30 N UNION RD
Second Line	:	STE 104
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5367
Country	:	US
Telephone Number	:	716-565-3990
Fax Number	:	716-565-3988

Provider Business Practice Location Address
First Line	:	30 N UNION RD
Second Line	:	STE 104
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5367
Country	:	US
Telephone Number	:	716-565-3990
Fax Number	:	716-565-3988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	01/26/2011

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