Provider Demographics
NPI:1235131913
Name:ERZURUM, SERGUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGUL
Middle Name:A
Last Name:ERZURUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DUTTON DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-1818
Mailing Address - Country:US
Mailing Address - Phone:330-746-7691
Mailing Address - Fax:330-743-8368
Practice Address - Street 1:10 DUTTON DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1818
Practice Address - Country:US
Practice Address - Phone:330-746-7691
Practice Address - Fax:330-743-8368
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35-058517E207WX0110X
OH35-058517207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000126327OtherANTHEM
OH180016191OtherRAILROAD MEDICARE
PA0014195190001OtherMEDICAID
OH050140OtherKEYSTONE
OHZ58517OtherSUMMACARE
OH0800396OtherUNITED HEALTHCARE
OH4323390OtherAETNA
OH82797OtherQUALCHOICE
OH0923335Medicaid
OHZ58517OtherSUMMACARE
OH0715861Medicare PIN