Provider Demographics
NPI:1073573218
Name:HERZIG, EDWARD B (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:HERZIG
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 1:5150 SANDY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2738
Mailing Address - Country:US
Mailing Address - Phone:513-896-9595
Mailing Address - Fax:513-896-4171
Practice Address - Street 1:5150 SANDY LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2738
Practice Address - Country:US
Practice Address - Phone:513-896-9595
Practice Address - Fax:513-896-4171
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038198207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00824188OtherMEDICARE RR
OH0377159Medicaid
OH0377159Medicaid
OHA77925Medicare UPIN