Provider Demographics
NPI:1619214756
Name:ZUFALL, ERIC J (PA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:J
Last Name:ZUFALL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:ERIC
Other - Middle Name:J
Other - Last Name:ZUFALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1425
Mailing Address - Fax:704-384-1426
Practice Address - Street 1:6909 PROSPERITY CHURCH RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6698
Practice Address - Country:US
Practice Address - Phone:704-384-1425
Practice Address - Fax:704-384-1426
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001004014363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1619214756OtherNPI
NC1528304235OtherNPI