Provider Demographics
NPI:1285615179
Name:HERTZER, NORMAN RAY (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:RAY
Last Name:HERTZER
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 1:38051 FAIRMOUNT BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HUNTING VALLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44022
Mailing Address - Country:US
Mailing Address - Phone:440-247-3809
Mailing Address - Fax:216-445-1521
Practice Address - Street 1:38051 FAIRMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:HUNTING VALLEY
Practice Address - State:OH
Practice Address - Zip Code:44022-6619
Practice Address - Country:US
Practice Address - Phone:440-247-3809
Practice Address - Fax:216-445-1521
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350393252086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0445094Medicaid
OHVA9923981Medicare ID - Type Unspecified
OH0445094Medicaid