Provider Demographics
NPI:1629465216
Name:MOORMAN, ERICA (MD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:MATHIEU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45012-0837
Mailing Address - Country:US
Mailing Address - Phone:513-454-1460
Mailing Address - Fax:513-737-1592
Practice Address - Street 1:903 NW WASHINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6367
Practice Address - Country:US
Practice Address - Phone:513-454-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.133833207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0291544Medicaid