Provider Demographics
NPI:1437191996
Name:ERLICH, VICTOR M (PHD, MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:ERLICH
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 N 115TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8425
Mailing Address - Country:US
Mailing Address - Phone:206-365-0111
Mailing Address - Fax:206-365-2980
Practice Address - Street 1:505 NE 87TH AVE STE 460
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1965
Practice Address - Country:US
Practice Address - Phone:360-514-7771
Practice Address - Fax:360-514-7769
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3702084N0400X
WAMD000265362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1060938Medicaid
WAG000108279Medicare ID - Type Unspecified
WA1060938Medicaid