Provider Demographics
NPI:1609041292
Name:DICKERT, ERIN JOHNSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:JOHNSTON
Last Name:DICKERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:JOANNA
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 26536
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-1536
Mailing Address - Country:US
Mailing Address - Phone:864-331-3230
Mailing Address - Fax:864-331-3236
Practice Address - Street 1:373 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3405
Practice Address - Country:US
Practice Address - Phone:864-331-3230
Practice Address - Fax:864-331-3236
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1431207V00000X
SC35489207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8157Medicare PIN