MEDICARE: BETHANY ANNE MCCARTHY PA-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	363A00000X	Physician Assistant	MA003296L	PA

General Provider Information

NPI Number	:	1619975695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY ANNE MCCARTHY PA-C

Provider Business Mailing Address
First Line	:	300 STATE ST FL 4
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16507-1427
Country	:	US
Telephone Number	:	814-877-4577
Fax Number	:	814-455-3001

Provider Business Practice Location Address
First Line	:	300 STATE ST FL 4
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16507-1427
Country	:	US
Telephone Number	:	814-877-4577
Fax Number	:	814-455-3001

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	01/13/2020

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