Provider Demographics
NPI:1063645034
Name:MARTELLA, ERIN LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LYNN
Last Name:MARTELLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LYNN
Other - Last Name:MCQUAIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1450 SCALP AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3321
Mailing Address - Country:US
Mailing Address - Phone:814-266-8466
Mailing Address - Fax:814-266-0177
Practice Address - Street 1:1450 SCALP AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3321
Practice Address - Country:US
Practice Address - Phone:814-266-8466
Practice Address - Fax:814-266-0177
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant