Provider Demographics
NPI:1912065970
Name:HERGAN, DAVID JEREMY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JEREMY
Last Name:HERGAN
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 1:410 SAYBROOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4777
Mailing Address - Country:US
Mailing Address - Phone:860-685-8940
Mailing Address - Fax:
Practice Address - Street 1:410 SAYBROOK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4777
Practice Address - Country:US
Practice Address - Phone:860-685-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47238-020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery