Provider Demographics
NPI:1821063439
Name:HERZOG, JOSHUA PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:PAUL
Last Name:HERZOG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:1400 JOHNSTON WILLIS DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4765
Practice Address - Country:US
Practice Address - Phone:804-379-8088
Practice Address - Fax:804-794-6067
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2020-09-02
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Provider Licenses
StateLicense IDTaxonomies
VA0101259034207XS0117X, 207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN265130KKKMedicare PIN
IN192770B5Medicare PIN
IN859910E1Medicare PIN