Provider Demographics
NPI:1184677635
Name:PAUL N ERCKMAN MD
Entity Type:Organization
Organization Name:PAUL N ERCKMAN MD
Other - Org Name:MONROE CHILDRENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:N
Authorized Official - Last Name:ERCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-289-2556
Mailing Address - Street 1:1307B EAST FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112
Mailing Address - Country:US
Mailing Address - Phone:704-289-2556
Mailing Address - Fax:704-282-1282
Practice Address - Street 1:1307B EAST FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112
Practice Address - Country:US
Practice Address - Phone:704-289-2556
Practice Address - Fax:704-282-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208000000X
NC16277208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930740Medicaid
NC30740OtherBLUE CROSS BLUE SHIELD
NC4491873OtherAETNA
NC249124OtherMAMSI
SCN16277OtherSC MEDICAID
NC4491873OtherAETNA
NC=========OtherUNITED HEALTHCARE
NC8930740Medicaid
NC=========OtherCHAMPUS