Provider Demographics
NPI:1225014996
Name:HERPEN, LORI A (DPM)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:HERPEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-5833
Mailing Address - Country:US
Mailing Address - Phone:440-992-4477
Mailing Address - Fax:440-998-5452
Practice Address - Street 1:3903 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5833
Practice Address - Country:US
Practice Address - Phone:440-992-4477
Practice Address - Fax:440-998-5452
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002795213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0903740Medicaid
OH0727552Medicare PIN
OHU36260Medicare UPIN