Provider Demographics
NPI:1982679866
Name:CONCANNON-FINK, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:CONCANNON-FINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 STATE ROUTE 257
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-2946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3512 STATE ROUTE 257
Practice Address - Street 2:SUITE 108
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2946
Practice Address - Country:US
Practice Address - Phone:814-677-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007789L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0014971680001OtherPROMISE NUMBER-WELFARE
441952OtherBC/BS
0014971680001OtherPROMISE NUMBER-WELFARE