Healthcare Provider Details

I. General information

NPI: 1497310478
Provider Name (Legal Business Name): EDWARD ERION
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS DRIVE MCDONNELL CENTER
ELKINS WV
26241
US

IV. Provider business mailing address

420 BAKER ST APT 1
ELKINS WV
26241-3304
US

V. Phone/Fax

Practice location:
  • Phone: 304-637-1397
  • Fax:
Mailing address:
  • Phone: 614-747-6037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000009427
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: