Provider Demographics
NPI:1790797454
Name:BOH, ERIN ELIZABETH (MD PHD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIZABETH
Last Name:BOH
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 TULANE AVE
Mailing Address - Street 2:TB36
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:504-988-5114
Mailing Address - Fax:504-988-7382
Practice Address - Street 1:1430 TULANE AVE
Practice Address - Street 2:TB36
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2632
Practice Address - Country:US
Practice Address - Phone:504-988-5114
Practice Address - Fax:504-988-7382
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018341207N00000X
MS13029207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1399906Medicaid
AL009954910Medicaid
MS00117131Medicaid
LAE14243Medicare UPIN
MS00117131Medicaid