Healthcare Provider Details

I. General information

NPI: 1619909850
Provider Name (Legal Business Name): THOMAS HERZOG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT, PHYS DIV
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-2323
  • Fax: 513-585-4893
Mailing address:
  • Phone: 513-585-2323
  • Fax: 513-585-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number231790-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number35 057399
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: