Provider Demographics
NPI:1023135340
Name:EDWARD L. ERB, D.O.
Entity type:Organization
Organization Name:EDWARD L. ERB, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ERB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-223-7106
Mailing Address - Street 1:4345 DELCO DELL RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1210
Mailing Address - Country:US
Mailing Address - Phone:937-298-5333
Mailing Address - Fax:937-298-5923
Practice Address - Street 1:5450 FAR HILLS AVE
Practice Address - Street 2:SUITE201
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2386
Practice Address - Country:US
Practice Address - Phone:937-291-0657
Practice Address - Fax:937-291-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340064912086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2466120Medicaid
OH2466120Medicaid
OH9343202Medicare PIN
OH0829339Medicare PIN
OH2466120Medicaid