Healthcare Provider Details

I. General information

NPI: 1700992427
Provider Name (Legal Business Name): MICHAEL A HERTZBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST 116A-PTSD
DURHAM NC
27705-3875
US

IV. Provider business mailing address

508 FULTON ST 116A-PTSD
DURHAM NC
27705-3875
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-0411
  • Fax: 919-286-6812
Mailing address:
  • Phone: 919-286-0411
  • Fax: 919-286-6812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33186
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: