Provider Demographics
NPI:1104895093
Name:HERCHELROATH, DEBORAH J (DO)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:HERCHELROATH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 VINE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-3565
Mailing Address - Country:US
Mailing Address - Phone:717-948-4150
Mailing Address - Fax:
Practice Address - Street 1:4000 VINE ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-3565
Practice Address - Country:US
Practice Address - Phone:717-948-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3786207V00000X
PAOS010298L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H65943Medicare UPIN