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General NPI Number Information
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NPI Number | 1861525263
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Entity Type | Organization
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Legal Business Name | ERIE MEDICAL SPECIALTY CLINIC, PC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 104 E 2ND ST THIRD FLOOR
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City | ERIE
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State | PA
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Zip | 16507-1532
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Country | US
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Telephone | 814-877-5564
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Fax | 814-877-5561
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Provider Business Mailing Address
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Address Line | 104 E 2ND ST THIRD FLOOR
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City | ERIE
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State | PA
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Zip | 16507-1532
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Country | US
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Telephone | 814-877-5564
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Fax | 814-877-5561
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Authorized Official
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Title or Position | MANAGER, CLINICAL ASSISTANT
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Name | MISS MARYBETH MARTIN
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Credential |
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Telephone | 814-877-5564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD025800E
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License Number State | PA
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