Provider Demographics
NPI:1528230679
Name:HERSCU, GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:HERSCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39141 CIVIC CENTER DR
Mailing Address - Street 2:STE 335
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5818
Mailing Address - Country:US
Mailing Address - Phone:510-248-1420
Mailing Address - Fax:510-791-2874
Practice Address - Street 1:39141 CIVIC CENTER DR
Practice Address - Street 2:STE # 335
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5818
Practice Address - Country:US
Practice Address - Phone:510-248-1420
Practice Address - Fax:510-791-2874
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA98129208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A981290Medicare PIN