MEDICARE: MRS. KATHLEEN MARIE MCNAMARA 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	25419	NY
2	363AM0700X	Medical Physician Assistant	1949	GA
3	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1841524501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN MARIE MCNAMARA PA-C

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVE BOX 667
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-1620
Country	:	US
Telephone Number	:	585-275-2647
Fax Number	:	585-275-0707

Provider Business Practice Location Address
First Line	:	601 ELMWOOD AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-1620
Country	:	US
Telephone Number	:	585-275-2647
Fax Number	:	585-275-0707

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

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	07/03/2023

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