Healthcare Provider Details

I. General information

NPI: 1871017285
Provider Name (Legal Business Name): CASSANDRA LOUISE ERDMAN PA-
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MARKET ST FL 7
PHILADELPHIA PA
19104-5545
US

IV. Provider business mailing address

3737 MARKET ST FL 7
PHILADELPHIA PA
19104-5545
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3340
  • Fax:
Mailing address:
  • Phone: 215-662-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA059385
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: