Provider Demographics
NPI:1922038322
Name:HERRICK, RICHARD EDWARD (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
Last Name:HERRICK
Suffix:
Gender:M
Credentials:DO
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-277-6050
Mailing Address - Fax:336-992-3141
Practice Address - Street 1:280 BROAD ST STE E
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2948
Practice Address - Country:US
Practice Address - Phone:336-277-6050
Practice Address - Fax:336-992-3141
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0144942084P0800X
NC2000004552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH31710Medicare UPIN