Provider Demographics
NPI:1689940710
Name:DEROUEN, ERKEDA LACHERISH (MD)
Entity Type:Individual
Prefix:DR
First Name:ERKEDA
Middle Name:LACHERISH
Last Name:DEROUEN
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 1:29 S PACA ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1771
Mailing Address - Country:US
Mailing Address - Phone:410-328-5012
Mailing Address - Fax:
Practice Address - Street 1:29 S PACA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1771
Practice Address - Country:US
Practice Address - Phone:410-328-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101265269207Q00000X
DCMD046844207Q00000X
390200000X
MDD79791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program