Healthcare Provider Details

I. General information

NPI: 1669661575
Provider Name (Legal Business Name): ERICKSON EMPLOYEE HEALTH AND WELLNESS CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 GRACEFIELD RD
SILVER SPRING MD
20904-1986
US

IV. Provider business mailing address

701 MAIDEN CHOICE LN
BALTIMORE MD
21228-5968
US

V. Phone/Fax

Practice location:
  • Phone: 443-883-4652
  • Fax: 443-883-4933
Mailing address:
  • Phone: 410-402-2261
  • Fax: 410-402-2264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW J. NARRETT
Title or Position: EXECUTIVE VP, CMO
Credential: MD
Phone: 410-402-2261