Basic Information
Provider Information
NPI: 1700138252
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GINSBERG
FirstName: ERICA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 4058
Address2:  
City: CROFTON
State: MD
PostalCode: 211144058
CountryCode: US
TelephoneNumber: 3012625852
FaxNumber: 3012623173
Practice Location
Address1: 13946 BALTIMORE AVE
Address2:  
City: LAUREL
State: MD
PostalCode: 207075000
CountryCode: US
TelephoneNumber: 3014982212
FaxNumber: 3014982213
Other Information
ProviderEnumerationDate: 10/09/2012
LastUpdateDate: 10/09/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X24207MDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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