=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023147006
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN A. WRIGHT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 04/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 646 KINGS HWY
-----------------------------------------------------
City | WEST DEPTFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08096-3145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-879-2887
-----------------------------------------------------
Fax | 856-879-2855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 402 LIPPINCOTT DR
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-4112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-782-3300
-----------------------------------------------------
Fax | 856-504-8029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | C7-0003285
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MT186337
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 25MA08366800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------