Provider Demographics
NPI:1811989072
Name:DEIRDRE A HERRINGTON MD, LTD
Entity type:Organization
Organization Name:DEIRDRE A HERRINGTON MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-774-0290
Mailing Address - Street 1:201 EXECUTIVE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1503
Mailing Address - Country:US
Mailing Address - Phone:336-774-0290
Mailing Address - Fax:336-774-9012
Practice Address - Street 1:201 EXECUTIVE PARK BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1503
Practice Address - Country:US
Practice Address - Phone:336-774-0290
Practice Address - Fax:336-774-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE54487Medicare UPIN
2328195Medicare ID - Type UnspecifiedGROUP PRICING NUMBER
NC2152820CMedicare PIN