Provider Demographics
NPI:1225113301
Name:ERICSON, DOUGLAS PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:ERICSON
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 1:14460 NEW FALLS OF NEUSE
Mailing Address - Street 2:SUITE 149-102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8227
Mailing Address - Country:US
Mailing Address - Phone:919-264-3363
Mailing Address - Fax:
Practice Address - Street 1:14460 NEW FALLS OF NEUSE
Practice Address - Street 2:SUITE 149-102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8227
Practice Address - Country:US
Practice Address - Phone:919-264-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology