Healthcare Provider Details

I. General information

NPI: 1487497319
Provider Name (Legal Business Name): VICTORIA JOAN BERLIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PEACH ST STE 102
ERIE PA
16507-1423
US

IV. Provider business mailing address

100 PEACH ST STE 102
ERIE PA
16507-1423
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-5700
  • Fax: 814-877-5655
Mailing address:
  • Phone: 814-877-5700
  • Fax: 814-877-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA006886
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA065591
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: