Provider Demographics
NPI:1760475107
Name:FENDER, ERWIN EDWARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERWIN
Middle Name:EDWARD
Last Name:FENDER
Suffix:
Gender:M
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 1:209 GLEN HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:24422-3527
Mailing Address - Country:US
Mailing Address - Phone:540-862-4475
Mailing Address - Fax:540-862-4475
Practice Address - Street 1:209 GLEN HAVEN DR
Practice Address - Street 2:
Practice Address - City:CLIFTON FORGE
Practice Address - State:VA
Practice Address - Zip Code:24422-3527
Practice Address - Country:US
Practice Address - Phone:540-862-4475
Practice Address - Fax:540-862-4475
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110000075363A00000X
WV218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA970011149OtherRAILROAD MEDICARE
VA1538982OtherUMWA
VA1538982OtherUMWA