Provider Demographics
NPI:1164622841
Name:ERICKSON, JASON MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:ERICKSON
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 1:1534 PARK AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1084
Mailing Address - Country:US
Mailing Address - Phone:215-538-6430
Mailing Address - Fax:484-893-7098
Practice Address - Street 1:1534 PARK AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1084
Practice Address - Country:US
Practice Address - Phone:215-538-6430
Practice Address - Fax:484-893-7098
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0165692081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MNENROLLEDMedicaid