1417028838 NPI number — NATASHA L HERZ MD PA

Table of content: (NPI 1417028838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417028838 NPI number — NATASHA L HERZ MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATASHA L HERZ MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417028838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4701 RANDOLPH RD
Provider Second Line Business Mailing Address:
G2
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-2259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-881-5701
Provider Business Mailing Address Fax Number:
301-881-5460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4701 RANDOLPH RD
Provider Second Line Business Practice Location Address:
G2
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-2259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-881-5701
Provider Business Practice Location Address Fax Number:
301-881-5460
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
301-881-5701

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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