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General NPI Number Information
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NPI Number | 1487645917
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Entity Type | Organization
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Legal Business Name | NORTHSHORE CLINICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 11/12/2012
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Provider Practice Location Address
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Address Line | 120 E 2ND ST THIRD FLOOR
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City | ERIE
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State | PA
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Zip | 16507-1537
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Country | US
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Telephone | 814-452-8300
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Fax | 814-452-8308
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Provider Business Mailing Address
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Address Line | 120 E 2ND ST THIRD FLOOR
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City | ERIE
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State | PA
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Zip | 16507-1537
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Country | US
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Telephone | 814-452-8300
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Fax | 814-452-8308
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Authorized Official
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Title or Position | BILLING AND CREDENTIALING SPECIALIS
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Name | MRS. CHERYL SEREMET
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Credential |
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Telephone | 814-452-8248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD030792E
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License Number State | PA
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