Provider Demographics
NPI:1356528186
Name:ERICKSON, MICHELLE LYNN (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-5001
Practice Address - Fax:717-851-5114
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434537207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119718OtherGEISINGER HEALTH PLAN
PA1572555OtherGATEWAY-WMG
PA210578OtherJOHNS HOPKINS
PA2051890OtherHIGHMARK BLUE SHIELD
PA244710OtherUNISON-WMG
PA102149715Medicaid
PA30147677OtherAMERIHEALTH CARITAS-GH
PA20077668OtherAMERIHEALTH MERCY-WMG
PA30124650OtherAMERIHEALTH MERCY - WSRH
PA9576176OtherAETNA
PA50078248OtherCAPITAL BLUE CROSS-WMG
PA20077668OtherAMERIHEALTH MERCY-WMG
PA119718OtherGEISINGER HEALTH PLAN
PA1572555OtherGATEWAY-WMG
PA102149715Medicaid