Provider Demographics
NPI:1932177813
Name:HERLICH, THELMA LUFTMAN (MD)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:LUFTMAN
Last Name:HERLICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THELMA
Other - Middle Name:
Other - Last Name:LUFTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:240 MOUNT LEBANON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1243
Mailing Address - Country:US
Mailing Address - Phone:412-561-7541
Mailing Address - Fax:412-561-2366
Practice Address - Street 1:240 MOUNT LEBANON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1243
Practice Address - Country:US
Practice Address - Phone:412-561-7541
Practice Address - Fax:412-561-2366
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041500E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011513690006Medicaid
PA555731OtherHIGHMARK BS
PA555731OtherHIGHMARK BS
F53775Medicare UPIN