Provider Demographics
NPI:1881655447
Name:DEFAZIO, ERIN E (MPAS)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:E
Last Name:DEFAZIO
Suffix:
Gender:F
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HOLIDAY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-2727
Mailing Address - Country:US
Mailing Address - Phone:412-444-0098
Mailing Address - Fax:
Practice Address - Street 1:400 HOLIDAY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-2727
Practice Address - Country:US
Practice Address - Phone:412-444-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050965363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP92351Medicare UPIN
PA093929Medicare ID - Type Unspecified