Provider Demographics
NPI:1174579296
Name:BLANTON, ERIKA M (MD)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:M
Last Name:BLANTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 LOCKGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1746
Mailing Address - Country:US
Mailing Address - Phone:804-359-8600
Mailing Address - Fax:
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-673-8791
Practice Address - Fax:804-673-3228
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022876174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006209394Medicaid
VA1174579296Medicaid
VA006209394Medicaid
VAB07252Medicare UPIN
VA1174579296Medicaid
VA019505V73Medicare PIN