Provider Demographics
NPI:1578739231
Name:FOLCH, ERIK EDUARDO (MD, MSC)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:EDUARDO
Last Name:FOLCH
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:ERIK
Other - Middle Name:EDUARDO
Other - Last Name:FOLCH-VIADERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MSC
Mailing Address - Street 1:185 PILGRIM ROAD
Mailing Address - Street 2:DEAC 201
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-632-8439
Mailing Address - Fax:
Practice Address - Street 1:185 PILGRIM RD
Practice Address - Street 2:DEAC 201
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5324
Practice Address - Country:US
Practice Address - Phone:617-632-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.011218207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518620Medicaid
MS00624305Medicaid
TN103I290064Medicare PIN
MS00624305Medicaid