Provider Demographics
NPI:1578756649
Name:ERICKSON, RALPH LOREN (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:LOREN
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 ROBERT GRANT AVE
Mailing Address - Street 2:DIVISION OF PREV. MED.; WRAIR
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-7500
Mailing Address - Country:US
Mailing Address - Phone:301-319-9423
Mailing Address - Fax:
Practice Address - Street 1:503 ROBERT GRANT AVE
Practice Address - Street 2:DIVISION OF PREV. MED.; WRAIR
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-7500
Practice Address - Country:US
Practice Address - Phone:301-319-9423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00239752083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine