Provider Demographics
NPI:1629031109
Name:HERRERA, GLORIA PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:PATRICIA
Last Name:HERRERA
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 1:3200 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8086
Mailing Address - Country:US
Mailing Address - Phone:919-783-8334
Mailing Address - Fax:919-783-8160
Practice Address - Street 1:3200 BLUE RIDGE RD
Practice Address - Street 2:SUITE 224
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8086
Practice Address - Country:US
Practice Address - Phone:919-783-8334
Practice Address - Fax:919-783-8160
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001243676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH04014Medicare UPIN