Provider Demographics
NPI:1982948147
Name:PHILSON, BRIDGER N (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIDGER
Middle Name:N
Last Name:PHILSON
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 1:232 W 25TH ST
Mailing Address - Street 2:3R
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16544-0002
Mailing Address - Country:US
Mailing Address - Phone:814-452-5530
Mailing Address - Fax:814-452-5419
Practice Address - Street 1:232 W 25TH ST
Practice Address - Street 2:3R
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16544-0002
Practice Address - Country:US
Practice Address - Phone:814-452-5530
Practice Address - Fax:814-452-5419
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant