Provider Demographics
NPI:1821036112
Name:DEEDE, ERIK P (MD)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:P
Last Name:DEEDE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 MASSACHUSETTS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:
Practice Address - Street 1:255 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-789-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216459207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH20633OtherLICENSE
FLTPME756OtherSTATE LICENSE
CT72462OtherSTATE LICENSE
UT13302318-1235OtherLICENSE
TXS9870OtherLICENSE
OH35C.000513OtherLICENSE
NV23517OtherLICENSE
TN62840OtherLICENSE
IL036154740OtherSTATE LICENSE
WI2860-320OtherLICENSE
KY54589OtherLICENSE
GA87614OtherSTATE LICENSE
ALMD.46048OtherSTATE LICENSE
FLTPME756OtherSTATE LICENSE