Provider Demographics
NPI:1831407444
Name:FLUHARTY, SHASE ERIC (PA-C)
Entity type:Individual
Prefix:
First Name:SHASE
Middle Name:ERIC
Last Name:FLUHARTY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:CHASE
Other - Middle Name:
Other - Last Name:FLUHARTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-376-1939
Practice Address - Fax:740-374-1693
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003111RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0070671Medicaid
OHH055590Medicare UPIN
OHH055590Medicare UPIN
OH0070671Medicaid