MEDICARE: DR. ELENA HERSCHDORFER DO

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	207Q00000X	Family Medicine Physician	U04643	FL
2	207Q00000X	Family Medicine Physician	OS15077	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548772650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELENA HERSCHDORFER DO

Provider Business Mailing Address
First Line	:	PO BOX 494205
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33949-4205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 LOVELAND BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-1813
Country	:	US
Telephone Number	:	941-833-6531
Fax Number	:	941-764-0259

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

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	06/01/2026

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