Provider Demographics
NPI:1346424744
Name:HERRINGTON, DEIRDRE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:
Last Name:HERRINGTON
Suffix:
Gender:F
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-774-9000
Mailing Address - Fax:336-774-9012
Practice Address - Street 1:201 EXECUTIVE PARK BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1503
Practice Address - Country:US
Practice Address - Phone:336-774-9000
Practice Address - Fax:336-774-9012
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6941993Medicaid
NC6941993Medicaid
NC2152820CMedicare PIN
NCNC5610AMedicare PIN