Provider Demographics
NPI:1689686180
Name:COLON, ERIC JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JOHN
Last Name:COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3451
Mailing Address - Country:US
Mailing Address - Phone:508-697-8276
Mailing Address - Fax:
Practice Address - Street 1:155 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3451
Practice Address - Country:US
Practice Address - Phone:508-697-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209346207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2073650OtherMASSHEALTH
MA2073650OtherMASSHEALTH