Provider Demographics
NPI:1306849849
Name:HERZ, DANIEL B (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:HERZ
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 1:282 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3322
Mailing Address - Country:US
Mailing Address - Phone:860-545-9000
Mailing Address - Fax:
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE C-925
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-5910
Practice Address - Fax:423-778-5915
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT331442088P0231X
TN546992088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT033144OtherMEDICAL LICENSE NUMBER
NY3S2872Medicare PIN
NY02161044Medicaid
VT1012801Medicaid
NH30206154Medicaid
F60979Medicare UPIN