Provider Demographics
NPI:1073558268
Name:PEDERSEN, ERIK ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:ANDREW
Last Name:PEDERSEN
Suffix:
Gender:M
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 4460
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-0460
Mailing Address - Country:US
Mailing Address - Phone:866-491-5807
Mailing Address - Fax:
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:ALEGENT BERGAN MERCY DEPT OF RADIOLOGY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2319
Practice Address - Country:US
Practice Address - Phone:402-398-6193
Practice Address - Fax:402-398-5702
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE222412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE22241OtherNE MEDICAL LICENSE
IA36667OtherIOWA MEDICAL LICENSE
BP88076311OtherDEA
NE280277Medicare PIN
NENA1356007Medicare PIN
NE22241OtherNE MEDICAL LICENSE
I16390Medicare UPIN
IAP00320409Medicare PIN
IA36667OtherIOWA MEDICAL LICENSE
NENA1355007Medicare PIN