Provider Demographics
NPI:1912949009
Name:BUCKWALTER, ERIC (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:BUCKWALTER
Suffix:
Gender:M
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 1:802 NEW HOLLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2163
Mailing Address - Country:US
Mailing Address - Phone:717-291-0700
Mailing Address - Fax:717-291-9634
Practice Address - Street 1:802 NEW HOLLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2163
Practice Address - Country:US
Practice Address - Phone:717-291-0700
Practice Address - Fax:717-291-9634
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP53355Medicare UPIN
PA098673NCGMedicare ID - Type Unspecified