Healthcare Provider Details

I. General information

NPI: 1639483225
Provider Name (Legal Business Name): MR. CHRISTOPHER GEORGE HERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WRIGHT PATTERSON AFB OH
45433-5529
US

IV. Provider business mailing address

2755 OLD WHIPP CT
CENTERVILLE OH
45440-2261
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-9506
  • Fax:
Mailing address:
  • Phone: 434-617-1554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: