Provider Demographics
NPI:1346231495
Name:HERR, MICHAEL BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRUCE
Last Name:HERR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5884
Mailing Address - Country:US
Mailing Address - Phone:410-761-6551
Mailing Address - Fax:410-766-2904
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:SUITE 600
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5884
Practice Address - Country:US
Practice Address - Phone:410-761-6551
Practice Address - Fax:410-766-2904
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2018-06-20
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Provider Licenses
StateLicense IDTaxonomies
MDD035699207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD53248-1500Medicaid
MD53248-1500Medicaid
MD53248-1500Medicaid
01--0564898OtherFEDERAL TAX ID NUMBER
MD53248-1500Medicaid