Provider Demographics
NPI:1215985320
Name:HERD, EDWIN P (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:P
Last Name:HERD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:78-6831 ALI'I DRIVE
Mailing Address - Street 2:SUITE 328
Mailing Address - City:KAILUA-KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740
Mailing Address - Country:US
Mailing Address - Phone:808-747-8321
Mailing Address - Fax:808-331-8682
Practice Address - Street 1:78-6831 ALI'I DRIVE
Practice Address - Street 2:SUITE 328
Practice Address - City:KAILUA-KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-747-8321
Practice Address - Fax:808-322-2502
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD14428208000000X
NC9701763208000000X
SD48802080P0203X
NV119632080P0205X
FLME167424208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6701490Medicaid
NV002019516Medicaid
NC891113QMedicaid
HI613100Medicaid
HI613100Medicaid
NC891113QMedicaid