Basic Information
Provider Information
NPI: 1003003955
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCARTHY
FirstName: MICHELLE
MiddleName: DOYLE
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: ELM AND CARLTON ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142630001
CountryCode: US
TelephoneNumber: 7168452300
FaxNumber: 7168452364
Practice Location
Address1: ELM AND CARLTON ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142630001
CountryCode: US
TelephoneNumber: 7168452300
FaxNumber: 7168452364
Other Information
ProviderEnumerationDate: 09/25/2007
LastUpdateDate: 02/02/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X011960NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

ID Information
IDTypeStateIssuerDescription
0297376005NY MEDICAID


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