Provider Demographics
NPI:1992856785
Name:HERRERA, IVONNE (MD)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 MIDDLEFORD RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3664
Mailing Address - Country:US
Mailing Address - Phone:302-628-8300
Mailing Address - Fax:302-628-8400
Practice Address - Street 1:1350 MIDDLEFORD RD
Practice Address - Street 2:SUITE 502
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3664
Practice Address - Country:US
Practice Address - Phone:302-628-8300
Practice Address - Fax:302-628-8400
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECI0006778207RR0500X
MDD0078900207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000021656Medicaid
196158YC36OtherPTAN
H81553Medicare UPIN