Provider Demographics
NPI:1154379238
Name:HERR, DOUGLAS V (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:V
Last Name:HERR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4109
Mailing Address - Country:US
Mailing Address - Phone:413-447-2752
Mailing Address - Fax:413-496-6836
Practice Address - Street 1:77 HOSPITAL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2550
Practice Address - Country:US
Practice Address - Phone:413-663-3400
Practice Address - Fax:413-663-5652
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49588207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB96335Medicare UPIN
MASX3746Medicare PIN