Provider Demographics
NPI:1871740902
Name:TEMOKA, ERICK DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:ERICK
Middle Name:DANIEL
Last Name:TEMOKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46440 BENEDICT DR STE 208
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-6602
Mailing Address - Country:US
Mailing Address - Phone:571-665-6500
Mailing Address - Fax:571-665-6501
Practice Address - Street 1:46440 BENEDICT DR STE 208
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6602
Practice Address - Country:US
Practice Address - Phone:571-665-6500
Practice Address - Fax:571-665-6501
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7919208000000X
VA0101268804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7738980Medicaid