Provider Demographics
NPI:1730323296
Name:JACKSON, ERIN W (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:W
Last Name:JACKSON
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 1:900 23RD ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2342
Mailing Address - Country:US
Mailing Address - Phone:202-741-2191
Mailing Address - Fax:202-741-2791
Practice Address - Street 1:900 23RD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2342
Practice Address - Country:US
Practice Address - Phone:202-715-4337
Practice Address - Fax:202-741-2791
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49778207RH0002X, 207R00000X, 208M00000X
IL036.139904207RH0002X
VA0101253099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01216006OtherRAILROAD
KY7100241590Medicaid
TN1531862Medicaid
TN6010875OtherBCBS
KY7100241590Medicaid