Provider Demographics
NPI:1851607212
Name:HERZER, LORE (MT-BC)
Entity Type:Individual
Prefix:MS
First Name:LORE
Middle Name:
Last Name:HERZER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 LOCUST LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4444
Mailing Address - Country:US
Mailing Address - Phone:717-526-2111
Mailing Address - Fax:717-526-2117
Practice Address - Street 1:4601 LOCUST LN
Practice Address - Street 2:SUITE 202
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4444
Practice Address - Country:US
Practice Address - Phone:717-526-2111
Practice Address - Fax:717-526-2117
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA09470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist