Provider Demographics
NPI:1336136274
Name:CONNOR, ERIKA (MD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:CONNOR
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 1:111 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NY
Mailing Address - Zip Code:14772-1131
Mailing Address - Country:US
Mailing Address - Phone:716-358-2340
Mailing Address - Fax:716-358-2350
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NY
Practice Address - Zip Code:14772-1131
Practice Address - Country:US
Practice Address - Phone:716-358-2340
Practice Address - Fax:716-358-2350
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01042479Medicaid
NY00010261902OtherUNIVERA
NY000511511006OtherBC/BS
NY0110256OtherIHA
NY000511511006OtherBC/BS
NY0110256OtherIHA