Provider Demographics
NPI:1902859309
Name:ERCKMAN, PAUL N (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:N
Last Name:ERCKMAN
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 1:1307B EAST FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5027
Mailing Address - Country:US
Mailing Address - Phone:704-289-2556
Mailing Address - Fax:704-282-1282
Practice Address - Street 1:1307B EAST FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5027
Practice Address - Country:US
Practice Address - Phone:704-289-2556
Practice Address - Fax:704-282-1282
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16277208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930740Medicaid
NC249124OtherMAMSI
NC30740OtherBLUE CROSS BLUE SHIELD
SCN16277Medicaid
NC4491878OtherAETNA
NC8930740Medicaid