Provider Demographics
NPI:1366534240
Name:HERTZOG, JAMES H (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:HERTZOG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:A.I. DUPONT HOSPITAL FOR CHILDREN
Practice Address - Street 2:1600 ROCKLAND ROAD
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-4000
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC100057532080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2067485Medicaid
IA543744Medicaid
SCQ05754Medicaid
NJ8053006Medicaid
NC7611186Medicaid
PA1773073Medicaid
DC476540Medicaid
VA6723195Medicaid
MD1522710Medicaid
PA1773073Medicaid
DC476540Medicaid