Provider Demographics
NPI:1225076417
Name:HERMAN, LEONARD Y (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:Y
Last Name:HERMAN
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:PO BOX 661688
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1688
Mailing Address - Country:US
Mailing Address - Phone:626-840-5655
Mailing Address - Fax:626-287-1940
Practice Address - Street 1:250 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4218
Practice Address - Country:US
Practice Address - Phone:626-840-5655
Practice Address - Fax:626-287-1940
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85589207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G855890OtherBLUE SHIELD
CA00G855890Medicaid
CAWG85589IMedicare PIN
CAC29396Medicare UPIN
CAWG85589CMedicare ID - Type Unspecified
CABS493ZMedicare PIN