Provider Demographics
NPI:1275746570
Name:GLASS, ERICKA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:RENEE
Last Name:GLASS
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 1:7442 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7022
Mailing Address - Country:US
Mailing Address - Phone:330-455-5367
Mailing Address - Fax:330-455-6114
Practice Address - Street 1:7442 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7022
Practice Address - Country:US
Practice Address - Phone:330-455-5367
Practice Address - Fax:330-455-6114
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436024207X00000X
OH35090407207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3051914Medicaid
OH3051914Medicaid