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NPI Code Detail

MEDICARE: JAMES KENNETH HERSTOFF M.D.

MEDICARE: JAMES KENNETH HERSTOFF 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
1207N00000XDermatology PhysicianMD04667RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20000000709OTHERRIBLUE CROSS BLUE SHIELD RI

General Provider Information

NPI Number : 1710980461
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES KENNETH HERSTOFF M.D.
Provider Business Mailing Address
First Line : 75 GIBBS AVE
Second Line :
City : NEWPORT
State : RI
Zip : 02840-2216
Country : US
Telephone Number : 401-849-2223
Fax Number :
Provider Business Practice Location Address
First Line : 75 GIBBS AVE
Second Line :
City : NEWPORT
State : RI
Zip : 02840-2216
Country : US
Telephone Number : 401-849-2223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2005
Last Update Date : 12/03/2007

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Directions to “ JAMES KENNETH HERSTOFF M.D.” Practice Location

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