Basic Information
| Provider Information | |||||||||
| NPI: | 1336348028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGRATH | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 TUNNEL ROAD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | POTTSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179013885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706225455 | ||||||||
| FaxNumber: | 5706225493 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 S BALLIET ST | ||||||||
| Address2: | |||||||||
| City: | FRACKVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179312105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708741491 | ||||||||
| FaxNumber: | 5708743404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 01/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | OA000905 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.