Provider Demographics
NPI:1952364507
Name:FLICKINGER, ERIC M (PAC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:M
Last Name:FLICKINGER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-632-5259
Mailing Address - Fax:717-632-2422
Practice Address - Street 1:207 BLOOMING GROVE RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7917
Practice Address - Country:US
Practice Address - Phone:717-632-5259
Practice Address - Fax:717-632-2422
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002937L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1569860OtherGATEWAY-WMG
PA1997092OtherHIGHMARK BLUE SHIELD FB
PA50073786OtherCAPITAL BLUE CROSS WMG
S84841Medicare UPIN
PA118995FLTMedicare PIN
PAP00657646Medicare PIN