Provider Demographics
NPI:1043286818
Name:ROYAL, ERICA MADLOCK (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MADLOCK
Last Name:ROYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6163
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23058-6163
Mailing Address - Country:US
Mailing Address - Phone:804-269-6889
Mailing Address - Fax:
Practice Address - Street 1:826 DAVIS ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7010
Practice Address - Country:US
Practice Address - Phone:540-443-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225372207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6207910Medicaid
160001829Medicare ID - Type Unspecified
H41283Medicare UPIN