Healthcare Provider Details

I. General information

NPI: 1548624018
Provider Name (Legal Business Name): ERIK JOHN RADICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 08/25/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN ST 117 CARY HALL
BUFFALO NY
14214-3001
US

IV. Provider business mailing address

ST. LUKE'S CVO 77 S COMMERCE WAY
BETHLEHEM PA
18017-8891
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-2012
  • Fax:
Mailing address:
  • Phone: 484-526-8046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD470735
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: