Healthcare Provider Details

I. General information

NPI: 1730384199
Provider Name (Legal Business Name): JEANINE HERDMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 VALLEY BROOK RD STE 500
MC MURRAY PA
15317-3378
US

IV. Provider business mailing address

174 E HIGHLAND DR
MC MURRAY PA
15317-3510
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-8760
  • Fax: 724-941-8795
Mailing address:
  • Phone: 724-941-8760
  • Fax: 724-941-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD437568
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: