Healthcare Provider Details

I. General information

NPI: 1164304903
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF ERIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 W 23RD ST
ERIE PA
16506-5803
US

IV. Provider business mailing address

1 LECOM PL
ERIE PA
16505-2571
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-2755
  • Fax: 814-456-4873
Mailing address:
  • Phone: 814-868-2529
  • Fax: 814-868-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEAN NEJMAN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 814-868-2507