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NPI Code Detail

MEDICARE: ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA

MEDICARE: ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA
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
1207QG0300XGeriatric Medicine (Family Medicine) Physician
2207Q00000XFamily Medicine Physician
3207RG0300XGeriatric Medicine (Internal Medicine) Physician
4363LA2200XAdult Health Nurse Practitioner
5363LG0600XGerontology Nurse Practitioner
6364SG0600XGerontology Clinical Nurse Specialist
7364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist
8207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101-29391OTHEREVERCARE
28BW701OTHERBCBS OF TX
304-60996OTHEREVERCARE
4260341853001OTHERTRICARE
50089EPOTHERBCBS - FEATHERSTON
60093NPOTHERBCBS OF TX
78AS969OTHERBCBS - FEATHERSTON

General Provider Information

NPI Number : 1164432639
Entity Type Code : Organization
Provider Name (Legal Business Name) : ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA
Provider Business Mailing Address
First Line : 5730 EXECUTIVE DR STE 230
Second Line :
City : CATONSVILLE
State : MD
Zip : 21228-1762
Country : US
Telephone Number : 972-232-8080
Fax Number : 972-232-8099
Provider Business Practice Location Address
First Line : 8000 FRANKFORD RD
Second Line :
City : DALLAS
State : TX
Zip : 75252-6834
Country : US
Telephone Number : 972-232-8080
Fax Number : 972-232-8099
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARY NORMAN
Credential : MD
Telephone Number : 410-402-2257
Provider Enumeration Date : 08/08/2006
Last Update Date : 12/08/2022

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Directions to “ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA ” Practice Location

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