Provider Demographics
NPI:1295783223
Name:GOSHORN, ERIN BOOHER (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:BOOHER
Last Name:GOSHORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1674 CRANIUM DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3583
Mailing Address - Country:US
Mailing Address - Phone:803-327-3937
Mailing Address - Fax:803-792-0545
Practice Address - Street 1:1674 CRANIUM DR STE 104
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3583
Practice Address - Country:US
Practice Address - Phone:803-327-3937
Practice Address - Fax:803-792-0545
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35592207W00000X
SC16005207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC2102OtherMEDCOST
SCNT5996Medicaid
SC000000293904OtherUNISON HEALTH PLAN SC
NCNC8936361Medicaid
SC20082415OtherSELECT HEALTH OF SC
NC356260OtherMAMSI
NCC2102OtherMEDCOST
NC356260OtherMAMSI
NCNC8936361Medicaid
SCNT5996Medicaid