Healthcare Provider Details

I. General information

NPI: 1104404060
Provider Name (Legal Business Name): CRAIG IMRE HERRFORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 RIVERCHASE BLVD
ROCK HILL SC
29732-1777
US

IV. Provider business mailing address

1436 RIVERCHASE BLVD
ROCK HILL SC
29732-1777
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-2636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberLL86354
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: