Provider Demographics
NPI:1649315060
Name:BRYANT, ERIN K (PA-C)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:K
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:K
Other - Last Name:MCCAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2337
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-2337
Mailing Address - Country:US
Mailing Address - Phone:315-701-5610
Mailing Address - Fax:
Practice Address - Street 1:7785 N STATE ST STE G-30
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-5861
Practice Address - Fax:315-376-5864
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051285363A00000X
NY011710363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011710OtherLICENSE NUMBER
PAMA051285OtherLICENSE NUMBER
NJQ31510Medicare UPIN