Provider Demographics
NPI:1043536170
Name:HERMAN, VICTORIA LEE (RT (R))
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEE
Last Name:HERMAN
Suffix:
Gender:F
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 69A
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE SMT
Mailing Address - State:PA
Mailing Address - Zip Code:16926-9748
Mailing Address - Country:US
Mailing Address - Phone:570-529-0539
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 69A
Practice Address - Street 2:
Practice Address - City:GRANVILLE SMT
Practice Address - State:PA
Practice Address - Zip Code:16926-9748
Practice Address - Country:US
Practice Address - Phone:570-529-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA428980247100000X
NY840930247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist