Provider Demographics
NPI:1619487014
Name:TROUPE, ERICA Q
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:Q
Last Name:TROUPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 GREENLEAF RD
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2279
Mailing Address - Country:US
Mailing Address - Phone:914-439-0574
Mailing Address - Fax:
Practice Address - Street 1:820 GREENLEAF RD
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2279
Practice Address - Country:US
Practice Address - Phone:914-439-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABLH-21441171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor