Provider Demographics
NPI:1235405085
Name:MEDICAL ASSOCIATES OF ERIE
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF ERIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-868-2501
Mailing Address - Street 1:1 LECOM PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2571
Mailing Address - Country:US
Mailing Address - Phone:814-868-2524
Mailing Address - Fax:
Practice Address - Street 1:75 W COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1135
Practice Address - Country:US
Practice Address - Phone:814-664-3981
Practice Address - Fax:814-664-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010664580001Medicaid