Provider Demographics
NPI:1326080961
Name:HERZBERG, DONALD L (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:HERZBERG
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 1:243 ELM ST
Mailing Address - Street 2:VALLEY REGIONAL HOSPITAL
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:243 ELM ST
Practice Address - Street 2:VALLEY REGIONAL HOSPITAL
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2005
Practice Address - Country:US
Practice Address - Phone:603-542-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH62812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1000675Medicaid
NH00000219Medicaid
NHE43342Medicare UPIN
VTVN0532Medicare PIN
VT1000675Medicaid