Provider Demographics
NPI:1639725872
Name:ERICKSON, MARGERY VANDERBILT
Entity Type:Individual
Prefix:
First Name:MARGERY
Middle Name:VANDERBILT
Last Name:ERICKSON
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 1:202 BANKERT RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-8613
Mailing Address - Country:US
Mailing Address - Phone:717-451-2479
Mailing Address - Fax:
Practice Address - Street 1:202 BANKERT RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-8613
Practice Address - Country:US
Practice Address - Phone:717-451-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker