Provider Demographics
NPI:1154301380
Name:ORISTIAN, ERIC ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALFRED
Last Name:ORISTIAN
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 1:2730 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1905
Mailing Address - Country:US
Mailing Address - Phone:301-942-4080
Mailing Address - Fax:301-942-4082
Practice Address - Street 1:2730 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 216
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1905
Practice Address - Country:US
Practice Address - Phone:301-942-4080
Practice Address - Fax:301-942-4082
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO24564208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9561OtherCAREFIRST BCBS NUMBER
MD25306OtherUNITED/MDIPA/OPT CHOICE
MDD0024564OtherMARYLAND LICENSE
MDB95011Medicare UPIN
MDOR446607Medicare PIN