Provider Demographics
NPI:1053303081
Name:ERB, JANE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:LOUISE
Last Name:ERB
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 1:85 EASTERN AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1869
Mailing Address - Country:US
Mailing Address - Phone:978-335-1396
Mailing Address - Fax:617-738-8703
Practice Address - Street 1:85 EASTERN AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1869
Practice Address - Country:US
Practice Address - Phone:978-335-1396
Practice Address - Fax:617-738-8703
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA742362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
105861OtherMAGELLAN
MA3080684Medicaid
ERA34876Medicare ID - Type Unspecified
J11434Medicare ID - Type Unspecified
E23404Medicare UPIN