Provider Demographics
NPI:1629465216
Name:MATHIEU, ERICA (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:MATHIEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-6078
Mailing Address - Country:US
Mailing Address - Phone:513-869-4917
Mailing Address - Fax:513-737-1592
Practice Address - Street 1:1036 S VERITY PKWY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5513
Practice Address - Country:US
Practice Address - Phone:513-454-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.133833207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0291544Medicaid