Organization
LAKE ERIE MEDICAL GROUP PC
Active
Other names
Niagara Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA L HATT (SENIOR ENROLLMENT SPECIALIST)
(814) 452-5772
Entity
Organization
Contact information
Practice address
2501 W 12TH ST STE C10, ERIE, PA 16505-4527
(814) 580-5600
(814) 455-2584
Mailing address
2501 W 12TH ST STE C10, ERIE, PA 16505-4527
(814) 580-5600
(814) 455-2584
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Enumeration date
10/11/2011
Last updated
12/15/2020
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