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General NPI Number Information
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NPI Number | 1013639541
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Entity Type | Individual
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Provider Name | CARLY ANN EHRGOTT PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 1200 OLD YORK RD
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City | ABINGTON
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State | PA
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Zip | 19001-3720
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Country | US
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Telephone | 215-481-4546
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Fax |
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Provider Business Mailing Address
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Address Line | 4 WOODBRIDGE CIR
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City | HORSHAM
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State | PA
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Zip | 19044-1117
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA006236
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA063896
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License Number State | PA
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