Provider Demographics
NPI:1821281601
Name:G FREDRICK HERDEL MD PA
Entity Type:Organization
Organization Name:G FREDRICK HERDEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWIDERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-423-2525
Mailing Address - Street 1:845 STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7271
Mailing Address - Country:US
Mailing Address - Phone:386-423-2550
Mailing Address - Fax:386-423-2525
Practice Address - Street 1:845 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7271
Practice Address - Country:US
Practice Address - Phone:386-423-2550
Practice Address - Fax:386-423-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 81028174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty