Healthcare Provider Details

I. General information

NPI: 1205867793
Provider Name (Legal Business Name): HERMAN J MICHAEL JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 SPRINGDALE DR SUITE 100
EXTON PA
19341
US

IV. Provider business mailing address

860 SPRINGDALE DR SUITE 100
EXTON PA
19341
US

V. Phone/Fax

Practice location:
  • Phone: 610-524-3703
  • Fax: 610-524-5990
Mailing address:
  • Phone: 610-524-3703
  • Fax: 610-524-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD034872E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1282870
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: