Provider Demographics
NPI:1083609713
Name:HERSCHER, ELLIOT STANTON (MD)
Entity Type:Individual
Prefix:MR
First Name:ELLIOT
Middle Name:STANTON
Last Name:HERSCHER
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 1:33001 SOLON RD
Mailing Address - Street 2:STE 206
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2839
Mailing Address - Country:US
Mailing Address - Phone:440-349-0067
Mailing Address - Fax:440-349-0292
Practice Address - Street 1:33001 SOLON RD
Practice Address - Street 2:STE 206
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2839
Practice Address - Country:US
Practice Address - Phone:440-349-0067
Practice Address - Fax:440-349-0292
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043707208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0457956Medicaid