Provider Demographics
NPI:1346774064
Name:FAIRCLOTH, ERIKA (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:
Last Name:FAIRCLOTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-1921
Mailing Address - Country:US
Mailing Address - Phone:860-679-4763
Mailing Address - Fax:860-679-4624
Practice Address - Street 1:79 RETREAT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2527
Practice Address - Country:US
Practice Address - Phone:860-972-0200
Practice Address - Fax:860-545-3149
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT66278207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program