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General NPI Number Information
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NPI Number | 1790318988
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Entity Type | Organization
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Legal Business Name | MEDICAL ASSOCIATES OF ERIE
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 4740 PEACH ST
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City | ERIE
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State | PA
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Zip | 16509-2008
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Country | US
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Telephone | 814-520-5652
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Fax | 814-616-8002
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Provider Business Mailing Address
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Address Line | 1 LECOM PL
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City | ERIE
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State | PA
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Zip | 16505-2571
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Country | US
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Telephone | 814-868-2507
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Fax | 814-868-2522
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | NICOLE GROSSI
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Credential |
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Telephone | 814-868-2507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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