Provider Demographics
NPI:1306863865
Name:CHOI, ERIC T (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:T
Last Name:CHOI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:3/208N
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3133
Mailing Address - Fax:215-707-3945
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:4TH FL PARKINSON PAVILION
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3133
Practice Address - Fax:215-707-3945
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-03-21
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Provider Licenses
StateLicense IDTaxonomies
MO20001574842085R0204X, 2086S0129X
PAMD4401602086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205023500Medicaid
MO205023500Medicaid
770002578Medicare PIN
102010181Medicare PIN
707390Medicare PIN