Provider Demographics
NPI:1437275088
Name:HERMAN, THEODORE SAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:SAUL
Last Name:HERMAN
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 1:140 FOUR SEASONS RD E
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4276
Mailing Address - Country:US
Mailing Address - Phone:716-834-0571
Mailing Address - Fax:716-834-0571
Practice Address - Street 1:140 FOUR SEASONS RD E
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4276
Practice Address - Country:US
Practice Address - Phone:716-834-0571
Practice Address - Fax:716-834-0571
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107582207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE15499Medicare ID - Type Unspecified