Provider Demographics
NPI:1548484090
Name:KARASKO, ERICH J (PA)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:J
Last Name:KARASKO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY DERMATOLOGY
Mailing Address - Street 2:593 EDDY ST, APC-10
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-4509
Mailing Address - Fax:401-444-7105
Practice Address - Street 1:60 HOSPITAL RD
Practice Address - Street 2:WACHUSCH EMERGENCY PHYSICIANS
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-2994
Practice Address - Fax:978-466-2993
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
RIPA00602363A00000X
MA1197363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P32387Medicare UPIN
MAAP1480Medicare ID - Type Unspecified