Healthcare Provider Details

I. General information

NPI: 1891961900
Provider Name (Legal Business Name): ERIN DUCHARME MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN MCKINLEY

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16349 SHERIDAN DRIVE SUITE 101
CLIVE IA
50325
US

IV. Provider business mailing address

16349 SHERIDAN AVE STE 101
CLIVE IA
50325-4675
US

V. Phone/Fax

Practice location:
  • Phone: 515-987-0333
  • Fax: 833-288-7944
Mailing address:
  • Phone: 515-987-0333
  • Fax: 833-288-7944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD-40967
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD-40967
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberMD-40967
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMD-40967
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD-40967
License Number StateIA
# 6
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD-40967
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: