Healthcare Provider Details

I. General information

NPI: 1700860707
Provider Name (Legal Business Name): ERICA NICOLE SMITH ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA NICOLE SMITH MD

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 KENDALL ST
WORCESTER MA
01605-2726
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-6255
  • Fax:
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301074536
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036117285
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1022361
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: