Healthcare Provider Details

I. General information

NPI: 1588078919
Provider Name (Legal Business Name): HERMAN SINGH JOHAL MD MPH FRCSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date: 01/15/2015
Reactivation Date: 02/06/2015

III. Provider practice location address

22 S. GREENE STREET, R ADAMS COWLEY SHOCK TRAUMA CENTER DIVISION OF ORTHOPAEDIC TRAUMATOLOGY
BALTIMORE MD
21201
US

IV. Provider business mailing address

22 S. GREENE STREET, R ADAMS COWLEY SHOCK TRAUMA CENTER DIVISION OF ORTHOPAEDIC TRAUMATOLOGY
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6280
  • Fax: 410-328-2893
Mailing address:
  • Phone: 410-328-6280
  • Fax: 410-328-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number111459
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: