Basic Information
| Provider Information | |||||||||
| NPI: | 1902867351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERMAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 714110 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432714110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402745000 | ||||||||
| FaxNumber: | 4402606153 | ||||||||
| Practice Location | |||||||||
| Address1: | 7956 TYLER BLVD | ||||||||
| Address2: | |||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440604806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402554455 | ||||||||
| FaxNumber: | 4402554487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 05/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35-050840 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000339406 | 01 | OH | ANTHEM | OTHER | 264200000 | 01 | OH | DEPT OF LABOR | OTHER | 264200000 | 01 | OH | FEDERAL BLACK LUNG | OTHER | 80507 | 01 | OH | QUALCHOICE | OTHER | 0660780 | 05 | OH | MEDICAID | 341425870042 | 01 | OH | MEDICAL MUTUAL OF OHIO | OTHER | 6600162 | 01 | OH | UNITED HEALTHCARE | OTHER |