Provider Demographics
NPI:1134143019
Name:VICARI, ERIN (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:VICARI
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 1:123 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3931
Mailing Address - Country:US
Mailing Address - Phone:219-213-2320
Mailing Address - Fax:219-663-7245
Practice Address - Street 1:123 N COURT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3931
Practice Address - Country:US
Practice Address - Phone:219-213-2320
Practice Address - Fax:219-663-4877
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061783A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000992402OtherANTHEM PIN
ININ2007008OtherMEDICARE PTAN
ININ2007008Medicare PIN
IN202790VVMedicare PIN