Healthcare Provider Details

I. General information

NPI: 1346627015
Provider Name (Legal Business Name): GRANT ERICKSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE ST
ERIE PA
16550-0002
US

IV. Provider business mailing address

2 BAYSHORE CT
GAITHERSBURG MD
20878-1973
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0092401
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD493465
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: