Healthcare Provider Details

I. General information

NPI: 1922057363
Provider Name (Legal Business Name): STEVEN T O'DONNELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/21/2023
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 W 38TH ST
ERIE PA
16508-1925
US

IV. Provider business mailing address

2115 W 38TH ST
ERIE PA
16508-1925
US

V. Phone/Fax

Practice location:
  • Phone: 814-722-6062
  • Fax: 814-722-6062
Mailing address:
  • Phone: 814-722-6062
  • Fax: 814-722-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS014076
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS014076
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: