Provider Demographics
NPI:1487627469
Name:HERTING, JUDY W (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:W
Last Name:HERTING
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:ONE CHILDREN'S PLAZA
Mailing Address - Street 2:CHILDREN'S ANESTHESIA GROUP, INC.
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1815
Mailing Address - Country:US
Mailing Address - Phone:937-641-3350
Mailing Address - Fax:937-641-6145
Practice Address - Street 1:ONE CHILDREN'S PLAZA
Practice Address - Street 2:CHILDREN'S ANESTHESIA GROUP, INC.
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1815
Practice Address - Country:US
Practice Address - Phone:937-641-3350
Practice Address - Fax:937-641-6145
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2014-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.055979207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0860359Medicaid
OH000000541690OtherANTHEM
OHF12690Medicare UPIN
OH0708151Medicare PIN