Provider Demographics
NPI:1336202407
Name:CATIPON, ERICSON ANGELES (MD)
Entity Type:Individual
Prefix:
First Name:ERICSON
Middle Name:ANGELES
Last Name:CATIPON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERICSON
Other - Middle Name:
Other - Last Name:CATIPON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:18579 CAPE JASMINE WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879
Mailing Address - Country:US
Mailing Address - Phone:301-977-8132
Mailing Address - Fax:410-350-8220
Practice Address - Street 1:3001 SOUTH HANOVER ST.,
Practice Address - Street 2:GRUEHN BLDG. SUITE 300
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225
Practice Address - Country:US
Practice Address - Phone:410-350-8222
Practice Address - Fax:410-350-8220
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD779131300Medicaid