Healthcare Provider Details

I. General information

NPI: 1841444056
Provider Name (Legal Business Name): ERIC PAUL ASP PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 08/25/2026
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 W MAIN ST
MOUNT JEWETT PA
16740-5128
US

IV. Provider business mailing address

333 STATE ST STE 103
ERIE PA
16507-1450
US

V. Phone/Fax

Practice location:
  • Phone: 814-778-2298
  • Fax: 814-778-7344
Mailing address:
  • Phone: 814-887-7157
  • Fax: 814-877-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA050967
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: