Provider Demographics
NPI:1154487270
Name:HERBERT, HENRY NICHOLAS (CONTRACTOR)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:NICHOLAS
Last Name:HERBERT
Suffix:
Gender:M
Credentials:CONTRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13819 THORNTON MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9662
Mailing Address - Country:US
Mailing Address - Phone:410-771-1558
Mailing Address - Fax:410-771-0321
Practice Address - Street 1:13819 THORNTON MILL RD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9662
Practice Address - Country:US
Practice Address - Phone:410-771-1558
Practice Address - Fax:410-771-0321
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD120109171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications