Provider Demographics
NPI:1659564557
Name:DESROSIERS, ERIN C (PA)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:C
Last Name:DESROSIERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4374 NEW TOWN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2865
Mailing Address - Country:US
Mailing Address - Phone:757-220-2795
Mailing Address - Fax:757-259-8797
Practice Address - Street 1:4374 NEW TOWN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2865
Practice Address - Country:US
Practice Address - Phone:757-220-2795
Practice Address - Fax:757-259-8797
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002569363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10023590OtherOPTIMA
VA1659864557Medicare UPIN
VA015005V25Medicare PIN