Provider Demographics
NPI:1861680134
Name:REGAN, ERIN COLLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:COLLEEN
Last Name:REGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:COLLEEN
Other - Last Name:WANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2406 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6678
Mailing Address - Country:US
Mailing Address - Phone:919-786-5001
Mailing Address - Fax:919-786-5051
Practice Address - Street 1:2406 BLUE RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6678
Practice Address - Country:US
Practice Address - Phone:919-786-5001
Practice Address - Fax:919-786-5051
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01636208000000X
CAA98582208000000X
PAMD446619208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2007-01636OtherLICENSE NUMBER