Healthcare Provider Details

I. General information

NPI: 1447407762
Provider Name (Legal Business Name): ERIN D DAUGHERTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WESCOTT DR
FLEMINGTON NJ
08822-4603
US

IV. Provider business mailing address

63 CHURCH ST
FLEMINGTON NJ
08822-1627
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6100
  • Fax:
Mailing address:
  • Phone: 908-788-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA002259
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053167
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00215200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: