MEDICARE: PATRICK T HERGENROEDER MD INC

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	174400000X	Specialist	35.038239	OH

General Provider Information

NPI Number	:	1689711533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK T HERGENROEDER MD INC

Provider Business Mailing Address
First Line	:	34 W WASHINGTON ST
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3026
Country	:	US
Telephone Number	:	440-247-2644
Fax Number	:	440-247-0131

Provider Business Practice Location Address
First Line	:	34 W WASHINGTON ST
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3026
Country	:	US
Telephone Number	:	440-247-2644
Fax Number	:	440-247-0131

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICK T HERGENROEDER
Credential	:	M.D.
Telephone Number	:	440-247-2644

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2020

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