Provider Demographics
NPI:1285945139
Name:BAZE, ERIGENA (DPM)
Entity type:Individual
Prefix:DR
First Name:ERIGENA
Middle Name:
Last Name:BAZE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 BRISTOL PIKE
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5210
Mailing Address - Country:US
Mailing Address - Phone:215-638-3338
Mailing Address - Fax:215-638-3030
Practice Address - Street 1:2222 BRISTOL PIKE
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5210
Practice Address - Country:US
Practice Address - Phone:215-245-1818
Practice Address - Fax:215-245-9129
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006186213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist