Provider Demographics
NPI:1902867351
Name:HERMAN, ROBERT GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GEORGE
Last Name:HERMAN
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:PO BOX 714110
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-4110
Mailing Address - Country:US
Mailing Address - Phone:440-274-5000
Mailing Address - Fax:440-260-6153
Practice Address - Street 1:7956 TYLER BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4806
Practice Address - Country:US
Practice Address - Phone:440-255-4455
Practice Address - Fax:440-255-4487
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-050840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000339406OtherANTHEM
OH264200000OtherDEPT OF LABOR
OH264200000OtherFEDERAL BLACK LUNG
OH80507OtherQUALCHOICE
OH0660780Medicaid
OH341425870042OtherMEDICAL MUTUAL OF OHIO
OH6600162OtherUNITED HEALTHCARE
OH6600162OtherUNITED HEALTHCARE
OH0660780Medicaid
OH4053908Medicare PIN
OHHE4053905Medicare ID - Type Unspecified
OH264200000OtherDEPT OF LABOR
OH264200000OtherFEDERAL BLACK LUNG
OH4053907Medicare PIN