Provider Demographics
NPI:1508891425
Name:ERHART, THOMAS P (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:ERHART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 ROUTE 112
Mailing Address - Street 2:BLDG 11 SUITE B
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8054
Mailing Address - Country:US
Mailing Address - Phone:631-474-4917
Mailing Address - Fax:631-331-1048
Practice Address - Street 1:1500-11 ROUTE 112
Practice Address - Street 2:SUITES A & B
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3060
Practice Address - Country:US
Practice Address - Phone:631-474-4917
Practice Address - Fax:631-331-1120
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193070207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF86013Medicare UPIN
NY48G531Medicare PIN
F86013Medicare UPIN