Provider Demographics
NPI:1720047558
Name:HERBERT, VIRGINIA L (MD, FACS)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:L
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GUYER ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1210
Mailing Address - Country:US
Mailing Address - Phone:603-727-2026
Mailing Address - Fax:
Practice Address - Street 1:7554 HOSPITAL DR STE D-303
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4178
Practice Address - Country:US
Practice Address - Phone:804-693-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14767207Q00000X, 208600000X
TXM3015208600000X
VA0101256109208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1720047558OtherBCBS
VT1017051Medicaid
NH14767OtherSTATE LICENSE
NH1720047558OtherANTHEM
NH3012207OtherMVP
NH30209202Medicaid
NHAA163726OtherHARVARD PILGRIM
NH3012207OtherMVP