1003099912 NPI number — ERICA J STOVSKY M.D.

Table of content: ERICA J STOVSKY M.D. (NPI 1003099912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003099912 NPI number — ERICA J STOVSKY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOVSKY
Provider First Name:
ERICA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1003099912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NEOMED 4209 ST RT 44 PO BOX 95
Provider Second Line Business Mailing Address:
DEPARTMENT OF INTERNAL MEDICINE, ATTN ERICA STOVSKY
Provider Business Mailing Address City Name:
ROOTSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-325-6795
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4209 ST RT 44
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROOTSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-325-6795
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2007

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: 207RH0002X , with the licence number:  35.094967 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35.094967 . This is a "STATE MEDICAL BOARD OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: MD443051 . This is a "PENNSYLVANIA STATE BOARD OF MEDICINE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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