Provider Demographics
NPI:1104249838
Name:HERMAN, THOMAS (CP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:HERMAN
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2209
Mailing Address - Country:US
Mailing Address - Phone:415-861-4146
Mailing Address - Fax:415-861-0653
Practice Address - Street 1:330 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2209
Practice Address - Country:US
Practice Address - Phone:415-861-4146
Practice Address - Fax:415-861-0653
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3889OtherABC