Provider Demographics
NPI:1114652799
Name:HERSCH, ROBERT MARK
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:HERSCH
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 1:658 LAUREL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2197
Mailing Address - Country:US
Mailing Address - Phone:614-532-6909
Mailing Address - Fax:614-478-9700
Practice Address - Street 1:658 LAUREL RIDGE DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2197
Practice Address - Country:US
Practice Address - Phone:614-532-6909
Practice Address - Fax:614-478-9700
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker