Provider Demographics
NPI:1598747370
Name:HERBERT, VICKI L (MD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:HERBERT
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 1:1518 FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-5112
Mailing Address - Country:US
Mailing Address - Phone:412-232-5546
Mailing Address - Fax:412-232-5548
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:STE 573
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3730
Practice Address - Country:US
Practice Address - Phone:412-469-3300
Practice Address - Fax:412-469-7226
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022995E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34893Medicare UPIN
PA70372JUNMedicare ID - Type Unspecified