MEDICARE: DANIEL B HERZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2088P0231X	Pediatric Urology Physician	33144	CT
2	2088P0231X	Pediatric Urology Physician	54699	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	033144	OTHER	CT	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1306849849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL B HERZ M.D.

Provider Business Mailing Address
First Line	:	282 WASHINGTON ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-3322
Country	:	US
Telephone Number	:	860-545-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	979 E 3RD ST
Second Line	:	SUITE C-925
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2136
Country	:	US
Telephone Number	:	423-778-5910
Fax Number	:	423-778-5915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	04/05/2023

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