Provider Demographics
NPI:1679756241
Name:OLSTAD, ERIK R (PAC)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:R
Last Name:OLSTAD
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BYBERRY RD
Mailing Address - Street 2:SUITE 705
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3518
Mailing Address - Country:US
Mailing Address - Phone:215-947-5005
Mailing Address - Fax:215-947-7590
Practice Address - Street 1:1800 BYBERRY RD
Practice Address - Street 2:SUITE 705
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3518
Practice Address - Country:US
Practice Address - Phone:215-947-5005
Practice Address - Fax:215-947-7590
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053282363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant