Provider Demographics
NPI:1952579997
Name:CHILDS, ERICA KRISTEN (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:KRISTEN
Last Name:CHILDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:KRISTEN
Other - Last Name:BLEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:236 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1495
Mailing Address - Country:US
Mailing Address - Phone:617-591-6300
Mailing Address - Fax:
Practice Address - Street 1:236 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1495
Practice Address - Country:US
Practice Address - Phone:617-591-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51057207R00000X
CAA116709207R00000X
MA242365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine