Healthcare Provider Details

I. General information

NPI: 1558005041
Provider Name (Legal Business Name): ERICA CONLON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA HEIDEN

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HERRICK ST STE 1003
BEVERLY MA
01915-2795
US

IV. Provider business mailing address

83 HERRICK ST STE 1003
BEVERLY MA
01915-2795
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-4980
  • Fax:
Mailing address:
  • Phone: 978-927-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1022976
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: