Provider Demographics
NPI:1497772016
Name:ERVIN, WILLIAM I (MD, FACEP)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:ERVIN
Suffix:I
Gender:M
Credentials:MD, FACEP
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:ERVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, FACEP
Mailing Address - Street 1:7 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:MANAKIN SABOT
Mailing Address - State:VA
Mailing Address - Zip Code:23103-2615
Mailing Address - Country:US
Mailing Address - Phone:804-784-4614
Mailing Address - Fax:
Practice Address - Street 1:7 QUAIL RUN DR
Practice Address - Street 2:
Practice Address - City:MANAKIN SABOT
Practice Address - State:VA
Practice Address - Zip Code:23103-2615
Practice Address - Country:US
Practice Address - Phone:804-784-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034662207P00000X
KY46824207P00000X
NMMD2013-0607207P00000X
ORMD169795207P00000X
WI60770-20207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005855560Medicaid
VA005855594Medicaid
VA005809967Medicaid
VA005810051Medicaid
VA005855578Medicaid
VA930001771Medicare UPIN
VA005809967Medicaid
VA930001253Medicare PIN
VA005855578Medicaid
VA005810051Medicaid
VA930001261Medicare PIN