Provider Demographics
NPI:1497774848
Name:HERFORT, OLIVER P (MD)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:P
Last Name:HERFORT
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 1:243 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743
Mailing Address - Country:US
Mailing Address - Phone:603-543-6900
Mailing Address - Fax:603-542-9497
Practice Address - Street 1:241 ELM STREET
Practice Address - Street 2:ASSOCIATES IN MEDICINE
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743
Practice Address - Country:US
Practice Address - Phone:603-543-6900
Practice Address - Fax:603-542-9497
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00068461OtherBLUE CROSS BLUE SHIELD VT
NH70001000Medicaid
NH01YP05036NH01OtherANTHEM
600347OtherHARVARD PILGRIM
VT1009816Medicaid
600347OtherHARVARD PILGRIM
NH70001000Medicaid