Provider Demographics
NPI:1215982962
Name:HERTZMAN-MILLER, RUTH P (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:P
Last Name:HERTZMAN-MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 HIGHLAND AVE
Mailing Address - Street 2:CHA - SOMERVILLE HOSPITAL PRIMARY CARE
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1495
Mailing Address - Country:US
Mailing Address - Phone:617-591-6300
Mailing Address - Fax:
Practice Address - Street 1:236 HIGHLAND AVE
Practice Address - Street 2:CHA - SOMERVILLE HOSPITAL PRIMARY CARE
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1495
Practice Address - Country:US
Practice Address - Phone:617-591-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2114488Medicaid
MAJ29651OtherBCBS MA
MA2114488Medicaid