MEDICARE: ERICA P. CERQUETTI

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	363LA2200X	Adult Health Nurse Practitioner	R174141	MD

General Provider Information

NPI Number	:	1134445372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA P. CERQUETTI

Provider Business Mailing Address
First Line	:	301 ST. PAUL PLACE
Second Line	:	MEDICAL STAFF OFFICE
City	:	BALTIMORE
State	:	MD
Zip	:	21202-2102
Country	:	US
Telephone Number	:	410-659-2802
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 POT SPRING ROAD
Second Line	:	MERCY RIDGE INC.
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093
Country	:	US
Telephone Number	:	410-561-0200
Fax Number	:

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

Provider Enumeration Date	:	04/13/2010
Last Update Date	:	02/19/2021

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