Healthcare Provider Details

I. General information

NPI: 1639325525
Provider Name (Legal Business Name): ERICKSON HEALTH MEDICAL GROUP OF HOWARD COUNTY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6334 CEDAR LN SUITE 103
COLUMBIA MD
21044-3898
US

IV. Provider business mailing address

813 MAIDEN CHOICE LN
CATONSVILLE MD
21228-3679
US

V. Phone/Fax

Practice location:
  • Phone: 410-910-6810
  • Fax: 410-910-6828
Mailing address:
  • Phone: 410-402-2257
  • Fax: 410-402-2264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW J NARRETT
Title or Position: SENIOR VP AND CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 410-402-2257