Provider Demographics
NPI:1689642274
Name:ERICKSON, ELIZABETH J (PA)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:J
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8019
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01102-8000
Mailing Address - Country:US
Mailing Address - Phone:866-431-4077
Mailing Address - Fax:413-774-7448
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:NORTHAMPTON HEALTH CENTER
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1466
Practice Address - Country:US
Practice Address - Phone:413-586-8400
Practice Address - Fax:413-585-5435
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA406363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA126881OtherFALLON
MA400006OtherCONNECTICARE, INC.
MA126881OtherFALLON
MAS75173Medicare UPIN