Provider Demographics
NPI:1316979248
Name:MACCARTHY, MEGAN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MACCARTHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:HOTCHKISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2200 DICKINSON RD
Mailing Address - Street 2:STE 17B
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-4056
Mailing Address - Country:US
Mailing Address - Phone:920-965-1234
Mailing Address - Fax:920-965-1232
Practice Address - Street 1:2200 DICKINSON RD STE 17B
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-4056
Practice Address - Country:US
Practice Address - Phone:920-965-1234
Practice Address - Fax:920-965-1232
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3477363AM0700X
WI3477-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ40067Medicare UPIN
ILK28751Medicare PIN
ILP00334703OtherRR MEDICARE