Provider Demographics
NPI:1679764088
Name:MCCLUSKEY, ERIN REBECCA (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:REBECCA
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:R
Other - Last Name:WEIBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1100 MONTOUR RD
Practice Address - Street 2:
Practice Address - City:LOYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17047-9200
Practice Address - Country:US
Practice Address - Phone:717-789-3553
Practice Address - Fax:717-789-4066
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053065363AM0700X
PAOA002218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031638440001Medicaid
1077454OtherNCCPA