Provider Demographics
NPI:1023638137
Name:DESMOND, ERIN A (PA-C)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:A
Last Name:DESMOND
Suffix:
Gender:F
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 1:275 VARNUM AVE SUITE 102
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854
Mailing Address - Country:US
Mailing Address - Phone:978-942-2610
Mailing Address - Fax:978-942-2616
Practice Address - Street 1:275 VARNUM AVE SUITE 102
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854
Practice Address - Country:US
Practice Address - Phone:978-942-2610
Practice Address - Fax:978-942-2616
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MAPA8189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400808223OtherMEDICARE PTN
MAPID110170641AMedicaid