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NPI Code Detail

MEDICARE: ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA

MEDICARE: ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician
2207QG0300XGeriatric Medicine (Family Medicine) Physician
3207RG0300XGeriatric Medicine (Internal Medicine) Physician
4213E00000XPodiatrist
5363LA2200XAdult Health Nurse Practitioner
6363LG0600XGerontology Nurse Practitioner
7364SG0600XGerontology Clinical Nurse Specialist
8364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist
9207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10089EPOTHERBCBS - FEATHERSTON
28AS969OTHERBCBS - FEATHERSTON
30093NPOTHERBCBS OF TX

General Provider Information

NPI Number : 1285654079
Entity Type Code : Organization
Provider Name (Legal Business Name) : ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA
Provider Business Mailing Address
First Line : 5730 EXECUTIVE DR STE 230
Second Line :
City : CATONSVILLE
State : MD
Zip : 21228-1762
Country : US
Telephone Number : 281-249-7100
Fax Number : 281-249-7365
Provider Business Practice Location Address
First Line : 14703 EAGLE VISTA DR
Second Line :
City : HOUSTON
State : TX
Zip : 77077-5275
Country : US
Telephone Number : 281-249-7100
Fax Number : 281-249-7365
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARY NORMAN
Credential : M.D.
Telephone Number : 410-402-2257
Provider Enumeration Date : 07/21/2006
Last Update Date : 12/08/2022

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Directions to “ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA ” Practice Location

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