Provider Demographics
NPI:1376603597
Name:HERMANN, JEFFREY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:HERMANN
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 1:300 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-2105
Mailing Address - Country:US
Mailing Address - Phone:717-718-5813
Mailing Address - Fax:717-505-7675
Practice Address - Street 1:300 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-2105
Practice Address - Country:US
Practice Address - Phone:717-718-5813
Practice Address - Fax:717-505-7675
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 068274L2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001797450-0003Medicaid
PA001797450-0001Medicaid
PA001797450-0004Medicaid
PA001797450-0005Medicaid
PA001797450-0006Medicaid
PA001797450-0007Medicaid
PA001797450-0002Medicaid
PA260043957Medicare ID - Type UnspecifiedRAILROAD
PA001797450-0006Medicaid
PA001797450-0003Medicaid