Provider Demographics
NPI:1215049903
Name:ALBERT, N. ERICK (MD)
Entity type:Individual
Prefix:
First Name:N. ERICK
Middle Name:
Last Name:ALBERT
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 1:830 S HAM LN
Mailing Address - Street 2:SUITE 26
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-7510
Mailing Address - Country:US
Mailing Address - Phone:209-368-6661
Mailing Address - Fax:209-333-7655
Practice Address - Street 1:830 S HAM LN
Practice Address - Street 2:SUITE 26
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-7510
Practice Address - Country:US
Practice Address - Phone:209-368-6661
Practice Address - Fax:209-333-7655
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23904208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA019751OtherHILL PHYSICIANS
CAG23904OtherLICENSE
CA340004485OtherRAILROAD MEDICARE
CA942415776OtherEIN
CA942415776OtherEIN