Provider Demographics
NPI:1164534665
Name:ERDMAN, MARK ALLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:ERDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 ALVERSER PLZ
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2604
Mailing Address - Country:US
Mailing Address - Phone:804-594-1944
Mailing Address - Fax:804-594-1945
Practice Address - Street 1:1336 ALVERSER PLZ
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2604
Practice Address - Country:US
Practice Address - Phone:804-594-1944
Practice Address - Fax:804-594-1945
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300935213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7330335OtherCIGNA
VA188610OtherANTHEM
VA2131963OtherMAMSI
VA5598322OtherFIRST HEALTH
VA010136296Medicaid
VA861077371OtherPHCS
VA7247698OtherAETNA
VA259460OtherSOUTHERN HEALTH
VA259460OtherSOUTHERN HEALTH
VAV00547Medicare UPIN
VA7247698OtherAETNA
VAC09007Medicare ID - Type UnspecifiedGROUP #
VA5598322OtherFIRST HEALTH