Provider Demographics
NPI:1205863396
Name:HERNDON, CLAUDE DAVID ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDE DAVID
Middle Name:ANTHONY
Last Name:HERNDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:SURGERY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-2467
Practice Address - Fax:804-628-5683
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101249154208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06700760OtherMISSISSIPPI MEDICAID
AL051516818OtherBLUE CROSS
AL051553940Medicare PIN
ALP00046556OtherRAILROAD MEDICARE