Provider Demographics
NPI:1336116045
Name:GIRARDOT, ERIC A (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:GIRARDOT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13225 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5480
Mailing Address - Country:US
Mailing Address - Phone:317-715-4863
Mailing Address - Fax:317-795-2047
Practice Address - Street 1:13225 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5480
Practice Address - Country:US
Practice Address - Phone:317-715-4863
Practice Address - Fax:317-795-2047
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002413363A00000X
IN1000557A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK27720Medicare PIN
P73281Medicare UPIN
ILK27721Medicare PIN