Provider Demographics
NPI:1134144553
Name:PALLIE, ERIKA ANNE (MD)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:ANNE
Last Name:PALLIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 CHEAT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-0022
Mailing Address - Country:US
Mailing Address - Phone:304-400-6145
Mailing Address - Fax:304-284-0031
Practice Address - Street 1:2195 CHEAT RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-0022
Practice Address - Country:US
Practice Address - Phone:304-400-6145
Practice Address - Fax:304-318-4584
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19248207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012399340001Medicaid
MD404265400Medicaid
WV0055354000Medicaid
WV7333401Medicare PIN
PA1012399340001Medicaid