Healthcare Provider Details

I. General information

NPI: 1548680960
Provider Name (Legal Business Name): ERIN ALICE BRICKLEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN ALICE MAJCHRZAK

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 N MAIN ST
MARION VA
24354-4312
US

IV. Provider business mailing address

1204 N MAIN ST
MARION VA
24354-4312
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-2511
  • Fax:
Mailing address:
  • Phone: 276-783-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102204742
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: