Healthcare Provider Details

I. General information

NPI: 1487119228
Provider Name (Legal Business Name): ERIN ROBERTS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN SHEA

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MEDICAL PARKWAY WAYSON PAVILION, SUITE 100
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

2003 MEDICAL PKWY STE 100
ANNAPOLIS MD
21401-3076
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-3493
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0007988
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: