Doctor Name: | DR. MATTHEW CAMPBELL ERICKSEN |
NPI Number: | 1285956797 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | |
Business Practice Address: | 736 Cambridge St Brighton, MA - 021352907 |
Business Phone Number: | 6177796441 |
Business Fax Number: | |
Mailing Address: | 156 Newton St, #5 BRIGHTON |
State: | MA |
Postal Code: | 021351526 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/25/2010 |
NPI Last Update Date: | 06/25/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |