Provider Demographics
NPI:1477574234
Name:HERMAN, JAY BERNARD (MD)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:BERNARD
Last Name:HERMAN
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 1:532 S AIKEN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232
Mailing Address - Country:US
Mailing Address - Phone:412-681-5433
Mailing Address - Fax:412-681-7321
Practice Address - Street 1:532 S AIKEN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232
Practice Address - Country:US
Practice Address - Phone:412-681-5433
Practice Address - Fax:412-681-7321
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA024103E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0450784OtherUSHC
1013373OtherGATEWAY
450784HMOOtherAETNA
4020832PPOOtherAETNA
PA0009518040003Medicaid
60570OtherTHREE RIVERS
60570OtherMED PLUS
1013373OtherGATEWAY
60570OtherTHREE RIVERS
PAHE194742Medicare PIN