Provider Demographics
NPI:1275682668
Name:PRESTON, ERIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:B
Last Name:PRESTON
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:CORPORATE CREDENTIALING
Mailing Address - Street 2:P.O. BOX 269
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19899
Mailing Address - Country:US
Mailing Address - Phone:302-651-5938
Mailing Address - Fax:302-651-6077
Practice Address - Street 1:JEFFERSON FACULTY PEDS DUPONT CHILDRENS HLTH PROGRAM
Practice Address - Street 2:833 CHESTNUT STREET EAST SUITE 300
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-6000
Practice Address - Fax:215-923-4267
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007178208000000X
PAMD421636208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I01455Medicare UPIN