Provider Demographics
NPI:1073642625
Name:HERRY, VICTOR E
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:E
Last Name:HERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 WOODYARD RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4264
Mailing Address - Country:US
Mailing Address - Phone:301-868-7333
Mailing Address - Fax:301-868-9023
Practice Address - Street 1:9001 WOODYARD RD STE C
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4264
Practice Address - Country:US
Practice Address - Phone:301-868-7333
Practice Address - Fax:301-868-9023
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD12438207R00000X
MDD0020986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD183731100Medicaid
MDB94571Medicare UPIN
MD183731100Medicaid