Provider Demographics
NPI:1447560743
Name:FORTIER, ERIC (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:FORTIER
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 1:130 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3825
Mailing Address - Country:US
Mailing Address - Phone:508-862-7575
Mailing Address - Fax:508-862-7362
Practice Address - Street 1:27 PARK STREET
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02061
Practice Address - Country:US
Practice Address - Phone:508-862-7575
Practice Address - Fax:508-862-7362
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4057363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical