Individual
ERIC D TETZLAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
333 COTTMAN AVE, PHILADELPHIA, PA 19111-2434
(215) 728-4300
Mailing address
333 COTTMAN AVE, PHILADELPHIA, PA 19111-2434
(215) 728-4300
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N7975
BLUE CROSS BLUE SHIELD
TX
01
—
P00272602
RAILROAD MEDICARE
TX
Enumeration date
10/23/2006
Last updated
12/21/2011
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