Provider Demographics
NPI:1265409577
Name:HERLAN, DAVID B (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:HERLAN
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:570-887-2290
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033834E208G00000X
NY227077-1208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGU039807OtherMEDICARE GROUP
NY02332850Medicaid
PA330005916OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
PA0019221460001Medicaid
NYCC8362OtherRR MEDICARE GROUP
NYP00213069OtherRR MEDICARE PIN
PA330005916OtherRR MEDICARE PIN
NYDD4479Medicare ID - Type Unspecified
PAGU039807OtherMEDICARE GROUP