Basic Information
Provider Information
NPI: 1689724692
EntityType: 2
ReplacementNPI:  
OrganizationName: ERICKSON HEALTH MEDICAL GROUP OF MARYLAND, PC
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Mailing Information
Address1: 5525 RESEARCH PARK DR
Address2: 4TH FLOOR
City: BALTIMORE
State: MD
PostalCode: 212284664
CountryCode: US
TelephoneNumber: 4104022258
FaxNumber: 4102047279
Practice Location
Address1: 711 MAIDEN CHOICE LN
Address2:  
City: CATONSVILLE
State: MD
PostalCode: 212283632
CountryCode: US
TelephoneNumber: 4102475602
FaxNumber: 4102471756
Other Information
ProviderEnumerationDate: 01/11/2007
LastUpdateDate: 07/18/2019
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AuthorizedOfficialLastName: NARRETT
AuthorizedOfficialFirstName: MATTHEW
AuthorizedOfficialMiddleName: J
AuthorizedOfficialTitleorPosition: VP AND CHIEF MEDICAL OFFICER
AuthorizedOfficialTelephone: 4104022257
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332B00000X  Y SuppliersDurable Medical Equipment & Medical Supplies 

ID Information
IDTypeStateIssuerDescription
554390000101 DMEOTHER


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