Provider Demographics
NPI:1215956727
Name:HERRING, MALCOLM B (MD)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:B
Last Name:HERRING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8433 HARCOURT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2190
Mailing Address - Country:US
Mailing Address - Phone:317-583-7600
Mailing Address - Fax:317-583-7601
Practice Address - Street 1:8433 HARCOURT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2190
Practice Address - Country:US
Practice Address - Phone:317-583-7600
Practice Address - Fax:317-583-7601
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023899A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
760000001OtherRAILROAD MEDICARE PIN
IN100326050AMedicaid
000000083143OtherBCBS PIN
000000083143OtherBCBS PIN
C24310Medicare UPIN