Provider Demographics
NPI:1063627479
Name:GIBLIN, ERICA M (MD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:M
Last Name:GIBLIN
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 1:13450 N MERIDIAN ST STE 135
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13450 N MERIDIAN ST STE 135
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1546
Practice Address - Country:US
Practice Address - Phone:317-582-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD75370208600000X
IN01074066A208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
V8380014OtherCAREFIRST
V8740014OtherCAREFIRST
MD652314500Medicaid
V8080014OtherCAREFIRST
281834YZ5Medicare PIN
V8380014OtherCAREFIRST
MD652314500Medicaid