Provider Demographics
NPI:1306807805
Name:HERSCHELMAN, PHILIP RONALD (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:RONALD
Last Name:HERSCHELMAN
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 1:14852 FOXVILLE- DEERFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:SABILLASVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21780
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6655 SYKESVILLE ROAD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784
Practice Address - Country:US
Practice Address - Phone:410-970-7000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00084052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B70386Medicare UPIN