Basic Information
| Provider Information | |||||||||
| NPI: | 1316042211 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDALLAH | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 WILMINGTON W CHESTER PIKE STE 214 | ||||||||
| Address2: | |||||||||
| City: | CHADDS FORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193179007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443657246 | ||||||||
| FaxNumber: | 6103617956 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 BRANDYWINE PKWY STE 202 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198031554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443657246 | ||||||||
| FaxNumber: | 3027921372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA057401 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | C5-0011425 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1065444 | 01 | NY | NCCPA NUMBER | OTHER |