Provider Demographics
NPI:1043295868
Name:HERLE, P. ANANDARAM (MD)
Entity Type:Individual
Prefix:
First Name:P. ANANDARAM
Middle Name:
Last Name:HERLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1907
Mailing Address - Country:US
Mailing Address - Phone:716-826-1881
Mailing Address - Fax:
Practice Address - Street 1:1370 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1907
Practice Address - Country:US
Practice Address - Phone:716-826-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111776207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000505460001OtherBSWNY
NY0400558OtherIHA
NY00010075401OtherUNIVERA
NY0076346OtherGHI
NY16101752201OtherNOVA
NY000505460001OtherBSWNY
NY0076346OtherGHI