Healthcare Provider Details

I. General information

NPI: 1679522957
Provider Name (Legal Business Name): HERMAN W. PALAT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 GRANT AVE SUITE 1B
PHILADELPHIA PA
19114-1004
US

IV. Provider business mailing address

P. O. BOX 8500-6335
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-671-8900
  • Fax: 215-671-1272
Mailing address:
  • Phone: 215-807-8000
  • Fax: 215-807-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS002817L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: