Provider Demographics
NPI:1477547560
Name:FIKRI, ERDEN (MD FACS)
Entity Type:Individual
Prefix:
First Name:ERDEN
Middle Name:
Last Name:FIKRI
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 MARKET ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1711
Mailing Address - Country:US
Mailing Address - Phone:814-535-3571
Mailing Address - Fax:814-535-3572
Practice Address - Street 1:353 MARKET ST
Practice Address - Street 2:SUITE 103
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1711
Practice Address - Country:US
Practice Address - Phone:814-535-3571
Practice Address - Fax:814-535-3572
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD033901L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006411220001Medicaid
PA0006411220001Medicaid
103779XYJMedicare PIN