Provider Demographics
NPI:1326029612
Name:HERNDON, JAMES H (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:HERNDON
Suffix:
Gender:M
Credentials:MD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8530
Practice Address - Fax:617-726-3124
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30047207X00000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6156002Medicaid
MA030047OtherTUFTS HEALTH PLAN
MAJ18482OtherBCBS MA
MA6156002Medicaid
MAA23236Medicare ID - Type Unspecified