Provider Demographics
NPI:1225021710
Name:HERKLOTS, ADRIAAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIAAN
Middle Name:R
Last Name:HERKLOTS
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 1:320 POMFRET ST
Mailing Address - Street 2:DKH PEDIATRIC CENTER
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1836
Mailing Address - Country:US
Mailing Address - Phone:860-963-6390
Mailing Address - Fax:860-963-6343
Practice Address - Street 1:320 POMFRET ST
Practice Address - Street 2:DKH PEDIATRIC CENTER
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1836
Practice Address - Country:US
Practice Address - Phone:860-963-6390
Practice Address - Fax:860-963-6343
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024321208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001243211Medicaid