Healthcare Provider Details

I. General information

NPI: 1578756649
Provider Name (Legal Business Name): RALPH LOREN ERICKSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 ROBERT GRANT AVE DIVISION OF PREV. MED.; WRAIR
SILVER SPRING MD
20910-7500
US

IV. Provider business mailing address

503 ROBERT GRANT AVE DIVISION OF PREV. MED.; WRAIR
SILVER SPRING MD
20910-7500
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-9423
  • Fax:
Mailing address:
  • Phone: 301-319-9423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0023975
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: