Provider Demographics
NPI:1548680960
Name:BRICKLEY, ERIN ALICE (DO)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ALICE
Last Name:BRICKLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ALICE
Other - Last Name:MAJCHRZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1204 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4312
Mailing Address - Country:US
Mailing Address - Phone:276-783-2511
Mailing Address - Fax:
Practice Address - Street 1:1204 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4312
Practice Address - Country:US
Practice Address - Phone:276-783-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204742208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1548680960Medicaid