Basic Information
| Provider Information | |||||||||
| NPI: | 1376749416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'NEILL | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4061 POWDER MILL RD | ||||||||
| Address2: | SUITE 210 - ATTN; LAURIE DAVIS | ||||||||
| City: | CALVERTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207053149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026698501 | ||||||||
| FaxNumber: | 2408461490 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 IRVING ST NW | ||||||||
| Address2: | DEPT OF RADIOLOGY | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200103017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028776429 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 08/28/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD042777 | DC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 087605400 | 05 | MD | MEDICAID | 1376749416 | 05 | VA | MEDICAID |