MEDICARE: TIMOTHY MICHAEL MCCARTY C-PA

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	363AM0700X	Medical Physician Assistant	1388	OH

General Provider Information

NPI Number	:	1790800357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY MICHAEL MCCARTY C-PA

Provider Business Mailing Address
First Line	:	450B WASHINGTON JACKSON RD STE 104
Second Line	:
City	:	EATON
State	:	OH
Zip	:	45320-7601
Country	:	US
Telephone Number	:	937-456-8340
Fax Number	:	937-456-8341

Provider Business Practice Location Address
First Line	:	450B WASHINGTON JACKSON RD STE 104
Second Line	:
City	:	EATON
State	:	OH
Zip	:	45320-7601
Country	:	US
Telephone Number	:	937-456-8340
Fax Number	:	937-456-8341

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	01/17/2019

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