MEDICARE: ERIN LOVE MCDERMOTT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	PA-1630	ID

General Provider Information

NPI Number	:	1790269389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN LOVE MCDERMOTT PA-C

Provider Business Mailing Address
First Line	:	2640 S EAGLE RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-6704
Country	:	US
Telephone Number	:	208-884-0835
Fax Number	:

Provider Business Practice Location Address
First Line	:	2640 S EAGLE RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-6704
Country	:	US
Telephone Number	:	208-884-0835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	03/09/2026

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Directions to “ ERIN LOVE MCDERMOTT PA-C” Practice Location

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