Healthcare Provider Details

I. General information

NPI: 1013190842
Provider Name (Legal Business Name): MR. HECTOR ERAZO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2007
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-4501
US

IV. Provider business mailing address

8505 LEXINGTON DR
SEVERN MD
21144-2729
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-6400
  • Fax:
Mailing address:
  • Phone: 443-839-6035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR131228
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: