Healthcare Provider Details

I. General information

NPI: 1801910880
Provider Name (Legal Business Name): ERIK B HURST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SUSHRUTA DR
MARTINSBURG WV
25401-8876
US

IV. Provider business mailing address

1000 SUSHRUTA DR
MARTINSBURG WV
25401-8876
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-3933
  • Fax:
Mailing address:
  • Phone: 304-263-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number22667
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number22667
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number22667
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number22667
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number22667
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: