Healthcare Provider Details

I. General information

NPI: 1821346933
Provider Name (Legal Business Name): ERIE PHYSICIAN NETWORK-UPMC,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 W 26TH ST LOWER LEVEL
ERIE PA
16508-1256
US

IV. Provider business mailing address

1781 W 26TH ST LOWER LEVEL
ERIE PA
16508-1256
US

V. Phone/Fax

Practice location:
  • Phone: 814-480-8960
  • Fax: 814-480-8970
Mailing address:
  • Phone: 814-480-8960
  • Fax: 814-480-8970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK EHALT
Title or Position: SR.DIRECTOR
Credential:
Phone: 412-647-0943