Provider Demographics
NPI:1295788081
Name:HERLAND, JONATHAN S (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:HERLAND
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 1:198 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-1836
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:198 HIGH ST
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-1836
Practice Address - Country:US
Practice Address - Phone:855-927-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115644174400000X
ME015192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7014011OtherAETNA
ME039403OtherANTHEM BCBS
MEG88039OtherHARVARD PILGRIM
ME720000129OtherRAILROAD MEDICARE
ME155430000Medicaid
ME155430000Medicaid
ME720000129OtherRAILROAD MEDICARE