Provider Demographics
NPI:1689711533
Name:PATRICK T HERGENROEDER MD INC
Entity Type:Organization
Organization Name:PATRICK T HERGENROEDER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HERGENROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-247-2644
Mailing Address - Street 1:34 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3026
Mailing Address - Country:US
Mailing Address - Phone:440-247-2644
Mailing Address - Fax:440-247-0131
Practice Address - Street 1:34 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-3026
Practice Address - Country:US
Practice Address - Phone:440-247-2644
Practice Address - Fax:440-247-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.038239174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty