Provider Demographics
NPI:1316042211
Name:ABDALLAH, ERICA (PA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ABDALLAH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 WILMINGTON W CHESTER PIKE STE 214
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9007
Mailing Address - Country:US
Mailing Address - Phone:844-365-7246
Mailing Address - Fax:610-361-7956
Practice Address - Street 1:3401 BRANDYWINE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1554
Practice Address - Country:US
Practice Address - Phone:844-365-7246
Practice Address - Fax:302-792-1372
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057401363A00000X, 363A00000X
DEC5-0011425363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1065444OtherNCCPA NUMBER
NYA400001938Medicare PIN
NYA400007776Medicare PIN