Provider Demographics
NPI:1629423041
Name:SADLER, ERIC A (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:SADLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 GATEWAY BLVD
Mailing Address - Street 2:STE 2120
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9460
Mailing Address - Country:US
Mailing Address - Phone:812-842-0907
Mailing Address - Fax:812-464-4485
Practice Address - Street 1:4015 GATEWAY BLVD
Practice Address - Street 2:STE 2120
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9460
Practice Address - Country:US
Practice Address - Phone:812-842-0907
Practice Address - Fax:812-464-4485
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
MT68491363AS0400X
IN10002141A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant