Provider Demographics
NPI:1053420612
Name:NORDIN, ERIC STANLEY (DO)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:STANLEY
Last Name:NORDIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3150
Mailing Address - Country:US
Mailing Address - Phone:937-277-9371
Mailing Address - Fax:937-277-7734
Practice Address - Street 1:5900 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3150
Practice Address - Country:US
Practice Address - Phone:937-277-9371
Practice Address - Fax:937-277-7734
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5835-N207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0966213Medicaid
OH0966218Medicaid
OH0804963Medicare PIN
OHN00804963Medicare ID - Type Unspecified
OHF77845Medicare UPIN