Healthcare Provider Details

I. General information

NPI: 1932369626
Provider Name (Legal Business Name): ERIN MCFADDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S WASHINGTON AVE STE 1000
SCRANTON PA
18505-3814
US

IV. Provider business mailing address

501 S WASHINGTON AVE STE 1000
SCRANTON PA
18505-3814
US

V. Phone/Fax

Practice location:
  • Phone: 570-941-0630
  • Fax: 570-343-3923
Mailing address:
  • Phone: 570-941-0630
  • Fax: 570-343-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD444352
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1026936680001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: