Provider Demographics
NPI:1962485748
Name:ERDMANN, ANTHONY CARL (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CARL
Last Name:ERDMANN
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 1:39 LYNN SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-4922
Mailing Address - Country:US
Mailing Address - Phone:617-429-8026
Mailing Address - Fax:617-977-1450
Practice Address - Street 1:39 LYNN SHORE DR
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4922
Practice Address - Country:US
Practice Address - Phone:617-429-8026
Practice Address - Fax:617-977-1450
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME923792084P0800X
MA742372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA74237OtherMASS. MEDICAL LICENSE
MA3081915Medicaid
FLME92379OtherFLORIDA MEDICAL LICENSE
BE2766650OtherDEA NUMBER
MA74237OtherMASS. MEDICAL LICENSE
MAJ11282Medicare ID - Type Unspecified