Provider Demographics
NPI:1578653853
Name:ERICSON, DAWN A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:A
Last Name:ERICSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:A
Other - Last Name:ERICSON WOODS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:103 ATHELSTANE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2422
Mailing Address - Country:US
Mailing Address - Phone:617-244-4640
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-1900
Practice Address - Fax:617-730-0084
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA790392080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3167980Medicaid
G19310Medicare UPIN
MA3167980Medicaid