Provider Demographics
NPI:1376808766
Name:LINE-NITU, ERIKA (DO)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:LINE-NITU
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 1:13 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2401
Mailing Address - Country:US
Mailing Address - Phone:781-354-4530
Mailing Address - Fax:
Practice Address - Street 1:102 SHORE DR STE 403
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3154
Practice Address - Country:US
Practice Address - Phone:508-852-5230
Practice Address - Fax:508-852-2447
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00773207Q00000X
MA260056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine