Provider Demographics
NPI:1306159819
Name:WADDINGTON, ERICA LOUISE (DO)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LOUISE
Last Name:WADDINGTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:LOUISE
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:130 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5921
Mailing Address - Country:US
Mailing Address - Phone:860-533-5673
Mailing Address - Fax:
Practice Address - Street 1:130 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5921
Practice Address - Country:US
Practice Address - Phone:860-533-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00746207Q00000X
CT53552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine