Provider Demographics
NPI:1013059476
Name:HERARD, CHRISTIAN RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:RENE
Last Name:HERARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TOLLGATE ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4448
Mailing Address - Country:US
Mailing Address - Phone:401-738-4014
Mailing Address - Fax:401-738-4090
Practice Address - Street 1:300 TOLLGATE ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4448
Practice Address - Country:US
Practice Address - Phone:401-738-4014
Practice Address - Fax:401-738-4090
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD04846207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
7600208OtherUNITED HEALTH CARE
RI001021OtherBLUE CHIP RI
RI7287OtherBLUE CROSS RI
RI9000728Medicaid
C90423Medicare UPIN
RI7287OtherBLUE CROSS RI