Basic Information
| Provider Information | |||||||||
| NPI: | 1548624018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RADICK | ||||||||
| FirstName: | ERIK | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | ST. LUKE'S CVO | ||||||||
| Address2: | 77 S COMMERCE WAY | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180178891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845268046 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3435 MAIN ST | ||||||||
| Address2: | 117 CARY HALL | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142143001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168292012 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD470735 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.