Provider Demographics
NPI:1174566483
Name:HERSCHTHAL, DAVID H (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:HERSCHTHAL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:7421 NORTH UNIVERSITY DR
Mailing Address - Street 2:STE 301
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321
Mailing Address - Country:US
Mailing Address - Phone:954-722-3900
Mailing Address - Fax:954-720-9720
Practice Address - Street 1:7280 W PALMETTO PARK RD STE 210
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3412
Practice Address - Country:US
Practice Address - Phone:613-919-2005
Practice Address - Fax:613-385-7027
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME31531207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79521ZMedicare Oscar/Certification
D58824Medicare UPIN