Provider Demographics
NPI:1255683637
Name:ROEDER, ERIKA R (PAC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:R
Last Name:ROEDER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:R
Other - Last Name:PETRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:434-243-3633
Practice Address - Fax:434-243-9511
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01655363AS0400X
VA0110004306363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical