Provider Demographics
NPI:1477540490
Name:KIM, ERICH N (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICH
Middle Name:N
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-4083
Mailing Address - Fax:717-812-2244
Practice Address - Street 1:35 MONUMENT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5074
Practice Address - Country:US
Practice Address - Phone:717-812-4083
Practice Address - Fax:717-812-2244
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038320E2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1521060OtherGATEWAY WMG
PA20069115OtherAMERIHEALTH MERCY-WMG
PA211160OtherJOHNS HOPKINS
PA432716OtherHIGHMARK BLUE SHIELD
PA50074890OtherCAPITAL BLUE CROSS-WMG
MD919374OtherCAREFIRST MD BCBS
PA000972143Medicaid
PA235830OtherUNISON-WMG
PA4269649OtherAETNA
MD550321300Medicaid
PA000972143Medicaid
PA235830OtherUNISON-WMG
PA211160OtherJOHNS HOPKINS