Healthcare Provider Details

I. General information

NPI: 1801838776
Provider Name (Legal Business Name): ROBERT DAVID HERSCOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5216 DAWES AVE
ALEXANDRIA VA
22311-1404
US

IV. Provider business mailing address

5216 DAWES AVE
ALEXANDRIA VA
22311-1404
US

V. Phone/Fax

Practice location:
  • Phone: 703-931-4746
  • Fax: 703-931-1794
Mailing address:
  • Phone: 703-931-4746
  • Fax: 703-931-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101055633
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: