Provider Demographics
NPI:1396142097
Name:D'ERAMO, REBECCA LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:D'ERAMO
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 1:107 GAMMA DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2917
Mailing Address - Country:US
Mailing Address - Phone:412-963-6677
Mailing Address - Fax:
Practice Address - Street 1:107 GAMMA DR
Practice Address - Street 2:SUITE 210
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2917
Practice Address - Country:US
Practice Address - Phone:412-963-6677
Practice Address - Fax:412-963-6868
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003454363A00000X
PAMA057261363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant