Provider Demographics
NPI:1508077801
Name:MAILLER, ERICA ANN (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:MAILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7335 W SAND LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5539
Mailing Address - Country:US
Mailing Address - Phone:407-352-8553
Mailing Address - Fax:407-351-8412
Practice Address - Street 1:7335 W SAND LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5539
Practice Address - Country:US
Practice Address - Phone:407-352-8553
Practice Address - Fax:407-351-8412
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 105564207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000567662OtherANTHEM
000000567662OtherANTHEM