Provider Demographics
NPI:1033897681
Name:SCHARLAU, ERIK LANCE (PA)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:LANCE
Last Name:SCHARLAU
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10799 MOLASSES HILL RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:NY
Mailing Address - Zip Code:14005-9757
Mailing Address - Country:US
Mailing Address - Phone:585-813-8847
Mailing Address - Fax:
Practice Address - Street 1:17 LANSING ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1983
Practice Address - Country:US
Practice Address - Phone:315-255-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY030321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program