Provider Demographics
NPI:1821036112
Name:DEEDE, ERIK P (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:P
Last Name:DEEDE
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 1:44 BROWE STREET
Mailing Address - Street 2:APT 3
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:508-383-1104
Mailing Address - Fax:
Practice Address - Street 1:115 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6358
Practice Address - Country:US
Practice Address - Phone:508-383-1104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216459207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH20633OtherLICENSE
TN62840OtherLICENSE
NV23517OtherLICENSE
OH35C.000513OtherLICENSE
KY54589OtherLICENSE
GA87614OtherSTATE LICENSE
FLTPME756OtherSTATE LICENSE
IL036154740OtherSTATE LICENSE
CT72462OtherSTATE LICENSE
ALMD.46048OtherSTATE LICENSE
TXS9870OtherLICENSE
UT13302318-1235OtherLICENSE
WI2860-320OtherLICENSE
FLTPME756OtherSTATE LICENSE