Provider Demographics
NPI:1740341486
Name:HERBERT, COURTNEY REGAN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:REGAN
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1715 NORTH GEORGE MASON DRIVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205
Mailing Address - Country:US
Mailing Address - Phone:703-310-7400
Mailing Address - Fax:703-574-3184
Practice Address - Street 1:1715 NORTH GEORGE MASON DRIVE
Practice Address - Street 2:SUITE 406
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205
Practice Address - Country:US
Practice Address - Phone:703-310-7400
Practice Address - Fax:703-574-3184
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036339207N00000X
VA0101241553207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H83380Medicare UPIN
P00478272Medicare PIN
G02678F01Medicare PIN