Provider Demographics
NPI:1851640833
Name:AN, ERIC (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:AN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MDS (AFMC)
Mailing Address - Street 2:90 VANDENBERG DRIVE, BLDG 1900
Mailing Address - City:HANSCOM AFB
Mailing Address - State:MA
Mailing Address - Zip Code:01731-2104
Mailing Address - Country:US
Mailing Address - Phone:781-225-6789
Mailing Address - Fax:781-225-2576
Practice Address - Street 1:66 MDS (AFMC)
Practice Address - Street 2:90 VANDENBERG DRIVE, BLDG 1900
Practice Address - City:HANSCOM AFB
Practice Address - State:MA
Practice Address - Zip Code:01731-2104
Practice Address - Country:US
Practice Address - Phone:781-225-6789
Practice Address - Fax:781-225-2576
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7068Medicaid
CA7420Medicaid