Provider Demographics
NPI:1386018398
Name:JACALA, ERIC (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:JACALA
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:800 SPRUCE STREET
Mailing Address - Street 2:1 CATHCART
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6130
Mailing Address - Country:US
Mailing Address - Phone:215-662-3340
Mailing Address - Fax:215-349-5890
Practice Address - Street 1:800 SPRUCE STREET
Practice Address - Street 2:1 CATHCART
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-662-3340
Practice Address - Fax:215-349-5890
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2021-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00384100363A00000X
PAMA058233363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant