MEDICARE: MR. THOMAS ELLIOT HERSCH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		GA

General Provider Information

NPI Number	:	1093027203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS ELLIOT HERSCH PA-C

Provider Business Mailing Address
First Line	:	1401 ROBERT B MILLER JR RD
Second Line	:	165 MDG, BLDG 301
City	:	SAVANNAH
State	:	GA
Zip	:	31408-9001
Country	:	US
Telephone Number	:	912-966-8531
Fax Number	:	912-966-8593

Provider Business Practice Location Address
First Line	:	1401 ROBERT B MILLER JR RD
Second Line	:	165 MDG, BLDG 301
City	:	SAVANNAH
State	:	GA
Zip	:	31408-9001
Country	:	US
Telephone Number	:	912-966-8531
Fax Number	:	912-966-8593

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	04/21/2017

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