Provider Demographics
NPI:1669823357
Name:HERRERA-MARTINEZ, MIGUEL
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:HERRERA-MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CHESTNUT ST
Mailing Address - Street 2:APT 1911
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2755
Mailing Address - Country:US
Mailing Address - Phone:586-381-8121
Mailing Address - Fax:
Practice Address - Street 1:301 CHESTNUT ST
Practice Address - Street 2:APT 1911
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2755
Practice Address - Country:US
Practice Address - Phone:586-381-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT211930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine