MEDICARE: MR. HECTOR ERAZO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R131228	MD

General Provider Information

NPI Number	:	1013190842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HECTOR ERAZO

Provider Business Mailing Address
First Line	:	8505 LEXINGTON DR
Second Line	:
City	:	SEVERN
State	:	MD
Zip	:	21144-2729
Country	:	US
Telephone Number	:	443-839-6035
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 WISCONSIN AVE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20889-4501
Country	:	US
Telephone Number	:	301-295-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2007
Last Update Date	:	03/31/2023

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