Provider Demographics
NPI:1821346933
Name:ERIE PHYSICIAN NETWORK-UPMC,INC
Entity Type:Organization
Organization Name:ERIE PHYSICIAN NETWORK-UPMC,INC
Other - Org Name:STEPHEN P.KROTH,DO LAC-UPMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR.DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EHALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-647-0943
Mailing Address - Street 1:1781 W 26TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1256
Mailing Address - Country:US
Mailing Address - Phone:814-480-8960
Mailing Address - Fax:814-480-8970
Practice Address - Street 1:1781 W 26TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1256
Practice Address - Country:US
Practice Address - Phone:814-480-8960
Practice Address - Fax:814-480-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA231347Medicare PIN