MEDICARE: PAUL F HERGENROEDER MD

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	35.087486	OH
2	207RH0003X	Hematology & Oncology Physician	35.087486	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140052	OTHER	PA	PA GROUP
2	0159	OTHER	PA	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942206388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL F HERGENROEDER MD

Provider Business Mailing Address
First Line	:	17876 SAINT CLAIR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-2602
Country	:	US
Telephone Number	:	216-383-2222
Fax Number	:	216-298-0241

Provider Business Practice Location Address
First Line	:	17876 SAINT CLAIR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110
Country	:	US
Telephone Number	:	216-383-2222
Fax Number	:	216-298-0241

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	06/26/2019

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Directions to “ PAUL F HERGENROEDER MD” Practice Location

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