Provider Demographics
NPI:1811982564
Name:HERTZBERG, TODD (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:HERTZBERG
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 1:441 HARTWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1197
Mailing Address - Country:US
Mailing Address - Phone:412-726-3502
Mailing Address - Fax:
Practice Address - Street 1:441 HARTWOOD TRL
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-1197
Practice Address - Country:US
Practice Address - Phone:412-726-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061814L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00140691OtherRR MED
PA1344344OtherBS
PA1869218Medicaid
PA1869218Medicaid
PA1344344OtherBS