Provider Demographics
NPI:1982651360
Name:ERICH, JENNIFER L (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:ERICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MOFFA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1718 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2926
Mailing Address - Country:US
Mailing Address - Phone:615-346-8546
Mailing Address - Fax:615-346-8547
Practice Address - Street 1:1718 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2926
Practice Address - Country:US
Practice Address - Phone:615-346-8546
Practice Address - Fax:615-346-8547
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070279L207P00000X
MDD47172207P00000X
TN65277207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1613627OtherGATEWAY
PA2742186OtherHIGHMARK BLUE SHIELD
PA102760401Medicaid
PA418989OtherUPMC
MD145691100Medicaid
PA30139168OtherAMERIHEALTH MERCY-YH
TNQ074709Medicaid
MDG03391Medicare UPIN
PA30139168OtherAMERIHEALTH MERCY-YH
MD145691100Medicaid
MDK727778NMedicare PIN