Basic Information
Provider Information
NPI: 1003258518
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CLINE
FirstName: ERICA
MiddleName: STOREY
NamePrefix: MRS.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 91734
Address2:  
City: RICHMOND
State: VA
PostalCode: 232911734
CountryCode: US
TelephoneNumber: 8043586100
FaxNumber: 8043427619
Practice Location
Address1: 1250 E MARSHALL ST
Address2: EMERGENCY MEDICINE
City: RICHMOND
State: VA
PostalCode: 232985051
CountryCode: US
TelephoneNumber: 8048280996
FaxNumber: 8048288646
Other Information
ProviderEnumerationDate: 07/25/2013
LastUpdateDate: 10/07/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X0110-004305VAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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