Healthcare Provider Details

I. General information

NPI: 1346774064
Provider Name (Legal Business Name): ERIKA FAIRCLOTH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 MILFORD ST
UPTON MA
01568-1309
US

IV. Provider business mailing address

236 MILFORD ST
UPTON MA
01568-1309
US

V. Phone/Fax

Practice location:
  • Phone: 508-473-1015
  • Fax:
Mailing address:
  • Phone: 508-473-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1017969
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: