Healthcare Provider Details

I. General information

NPI: 1528591484
Provider Name (Legal Business Name): DAVID GEORGE HERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE NW3300
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST STE 3300
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8394
  • Fax: 937-641-2780
Mailing address:
  • Phone: 937-208-8394
  • Fax: 937-641-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2022-00937
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.138004
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: