Provider Demographics
NPI:1457449407
Name:HERNDON, ELENA F (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:F
Last Name:HERNDON
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 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:434-924-5348
Practice Address - Fax:434-924-8335
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25308AL2084P0800X
VA01012497092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00078330OtherMEDICARE RAILROAD
AL051517422OtherBLUE CROSS
AL203281200OtherUS DEPARTMENT OF LABOR
AL51519732OtherFEDERAL BLUE CROSS
AL051517422OtherBLUE CROSS
AL051554050Medicare PIN