Healthcare Provider Details

I. General information

NPI: 1487645917
Provider Name (Legal Business Name): NORTHSHORE CLINICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 2ND ST THIRD FLOOR
ERIE PA
16507-1537
US

IV. Provider business mailing address

120 E 2ND ST THIRD FLOOR
ERIE PA
16507-1537
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-8300
  • Fax: 814-452-8308
Mailing address:
  • Phone: 814-452-8300
  • Fax: 814-452-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD030792E
License Number StatePA

VIII. Authorized Official

Name: MRS. CHERYL SEREMET
Title or Position: BILLING AND CREDENTIALING SPECIALIS
Credential:
Phone: 814-452-8248