Provider Demographics
NPI:1811020670
Name:HERTZIG, JEREMY STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:STEWART
Last Name:HERTZIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3842 INTERLAKE AVE N
Mailing Address - Street 2:APT. 1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103
Mailing Address - Country:US
Mailing Address - Phone:802-734-8762
Mailing Address - Fax:
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:PEDIATRIC INTENSIVE CARE UNIT
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:802-847-3544
Practice Address - Fax:802-847-5557
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0600003152208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTRES000Medicare UPIN