Provider Demographics
NPI:1801869789
Name:STORM, ERIK STEPHEN (DO)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:STEPHEN
Last Name:STORM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 STONECROFT CT
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-7604
Mailing Address - Country:US
Mailing Address - Phone:757-778-5461
Mailing Address - Fax:
Practice Address - Street 1:3485 SW BOND AVE FL 9
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4503
Practice Address - Country:US
Practice Address - Phone:503-494-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO1956352085R0202X
VA01022014452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00844141OtherRAILROAD MEDICARE
VA10060206OtherSENTARA
VA1801869789OtherVA PREMIER HEALTH PLAN
VA139178OtherBCBS
VA10060206OtherOPTIMA HEALTH
NC5907239Medicaid
VA1801869789Medicaid
VA10060206OtherSENTARA