MEDICARE: MARK KELLAND HERSCHEL M.D.

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	207W00000X	Ophthalmology Physician	ME77485	FL
2	207WX0120X	Cornea and External Diseases Specialist Physician	ME77485	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	400650	OTHER	FL	GHI
2	20922	OTHER	FL	BCBS
3	2439416	OTHER	FL	AETNA HMO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1476870	OTHER	FL	CIGNA
6	209665	OTHER	FL	WELL CARE
7	5014060	OTHER	FL	AETNAPPO/POS
8	1689235	OTHER	FL	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1124083068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK KELLAND HERSCHEL M.D.

Provider Business Mailing Address
First Line	:	5452 LAKE HOWELL RD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792
Country	:	US
Telephone Number	:	407-894-8081
Fax Number	:	407-894-8082

Provider Business Practice Location Address
First Line	:	5452 LAKE HOWELL ROAD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792
Country	:	US
Telephone Number	:	407-894-8081
Fax Number	:	407-894-8082

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	02/14/2023

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