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General NPI Number Information
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NPI Number | 1194498295
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Entity Type | Individual
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Provider Name | ERIN LYNN GILLESPIE PA-S
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Gender | Female
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 822 PINE ST STE 2A
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City | PHILADELPHIA
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State | PA
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Zip | 19107-6187
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Country | US
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Telephone | 267-519-0154
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Fax |
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Provider Business Mailing Address
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Address Line | 840 PALOMINO DR
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-1246
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Country | US
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Telephone | 484-340-0967
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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 | MA064180
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License Number State | PA
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