Healthcare Provider Details

I. General information

NPI: 1891704003
Provider Name (Legal Business Name): ELEANOR A ERWIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MONTICELLO AVE
WILLIAMSBURG VA
23185-2833
US

IV. Provider business mailing address

460 MCLAWS CIR SUITE 220
WILLIAMSBURG VA
23185-5671
US

V. Phone/Fax

Practice location:
  • Phone: 757-259-6000
  • Fax:
Mailing address:
  • Phone: 757-221-7111
  • Fax: 757-221-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101239872
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: