Provider Demographics
NPI:1750664090
Name:COLARUSSO, ERIN A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:A
Last Name:COLARUSSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:A
Other - Last Name:LISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:675 BALTIMORE DR
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-7900
Practice Address - Country:US
Practice Address - Phone:570-808-5441
Practice Address - Fax:570-808-5371
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002770363A00000X, 363AS0400X
PAMA055039363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical