Provider Demographics
NPI:1730167131
Name:BERRY, ERIN CALDWELL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:CALDWELL
Last Name:BERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002107363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730167131OtherMEDICAID QMB
VA1730167131OtherAETNA
VA1730167131OtherANTHEM MEDIGAP
VA1730167131OtherOPTIMA HEALTH PLAN
VA1730167131OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1730167131OtherHUMANA MEDICARE
VA1730167131OtherCCC VIRGINIA PREMIER
VA371194700OtherBLACK LUNG
VA540506332199OtherTRICARE/CHAMPUS
VA1730167131OtherINTOTAL
VAP00822162OtherRAILROAD MEDICARE
Q52075Medicare UPIN
VA1730167131OtherAETNA