Provider Demographics
NPI:1689779795
Name:OLIVER, ERIN M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:M
Last Name:OLIVER
Suffix:
Gender:F
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 1:87 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3718
Mailing Address - Country:US
Mailing Address - Phone:781-444-4050
Mailing Address - Fax:
Practice Address - Street 1:500 BROOKLINE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5417
Practice Address - Country:US
Practice Address - Phone:617-732-8725
Practice Address - Fax:617-975-0989
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS88717Medicare UPIN