1962485748 NPI number — ANTHONY CARL ERDMANN M.D.

Table of content: (NPI 1558452375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962485748 NPI number — ANTHONY CARL ERDMANN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERDMANN
Provider First Name:
ANTHONY
Provider Middle Name:
CARL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962485748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 LYNN SHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01902-4922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-429-8026
Provider Business Mailing Address Fax Number:
617-977-1450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 LYNN SHORE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01902-4922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-429-8026
Provider Business Practice Location Address Fax Number:
617-977-1450
Provider Enumeration Date:
11/25/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME92379 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 74237 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 74237 . This is a "MASS. MEDICAL LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3081915 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME92379 . This is a "FLORIDA MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".