Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 0101263903 | VA |
NPI | 1104212414 |
---|---|
Provider Name | Joshua Erickson |
First Address | Norfolk, VA 23507-1515 |
Second Address | Norfolk, VA 23502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2015 |
Last Update Date | 12/05/2020 |