Healthcare Provider Details

I. General information

NPI: 1134445372
Provider Name (Legal Business Name): ERICA P. CERQUETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 POT SPRING ROAD MERCY RIDGE INC.
LUTHERVILLE MD
21093
US

IV. Provider business mailing address

301 ST. PAUL PLACE MEDICAL STAFF OFFICE
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-561-0200
  • Fax:
Mailing address:
  • Phone: 410-659-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR174141
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: