MEDICARE: JANE LOUISE ERB MD

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	2084P0800X	Psychiatry Physician	MA74236	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105861	OTHER		MAGELLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053303081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE LOUISE ERB MD

Provider Business Mailing Address
First Line	:	85 EASTERN AVE
Second Line	:	SUITE 206
City	:	GLOUCESTER
State	:	MA
Zip	:	01930-1869
Country	:	US
Telephone Number	:	978-335-1396
Fax Number	:	617-738-8703

Provider Business Practice Location Address
First Line	:	85 EASTERN AVE
Second Line	:	SUITE 206
City	:	GLOUCESTER
State	:	MA
Zip	:	01930-1869
Country	:	US
Telephone Number	:	978-335-1396
Fax Number	:	617-738-8703

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	05/20/2008

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