Provider Demographics
NPI:1558463125
Name:ERICKSON, ELIZABETH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:ERICKSON
Suffix:
Gender:F
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:PSC 94 BOX 2461
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824
Mailing Address - Country:TR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 7095 BOX 185
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:NY
Practice Address - Zip Code:09824
Practice Address - Country:TR
Practice Address - Phone:90322-316-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059762A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine