Provider Demographics
NPI:1073649265
Name:MCDADE, ERIC MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MARTIN
Last Name:MCDADE
Suffix:
Gender:M
Credentials:DO
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 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-1408
Mailing Address - Fax:314-286-1985
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV NEUROLOGY AGING AND DEMENTIA, STE 6C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-1408
Practice Address - Fax:314-286-1985
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160003552084N0400X
PAOS0152642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200028119Medicaid
ILENROLLEDMedicaid
MNENROLLEDMedicaid
PA1025008970001Medicaid