Provider Demographics
NPI:1386987006
Name:BOSTICK, ERICA ALLISON (MD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:ALLISON
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:ALLISON
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 690
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-1716
Mailing Address - Country:US
Mailing Address - Phone:585-275-2964
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-1716
Practice Address - Country:US
Practice Address - Phone:585-275-2964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2939532080A0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine