Provider Demographics
NPI:1962820688
Name:DEWITT, ERICA JOY (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:JOY
Last Name:DEWITT
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 1:4950 COMMUNICATION AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-3308
Mailing Address - Country:US
Mailing Address - Phone:561-982-4300
Mailing Address - Fax:
Practice Address - Street 1:2700 QUARRY LAKE DR STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3762
Practice Address - Country:US
Practice Address - Phone:410-415-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0091918207R00000X
MEMD23702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty