Provider Demographics
NPI:1174051254
Name:PRIDGEN, ERIC MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MICHAEL
Last Name:PRIDGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 S 9TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-2517
Mailing Address - Country:US
Mailing Address - Phone:484-526-1735
Mailing Address - Fax:833-550-9700
Practice Address - Street 1:575 S 9TH ST STE 5
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-2517
Practice Address - Country:US
Practice Address - Phone:484-526-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481958207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20112933Medicaid