Provider Demographics
NPI:1306873724
Name:HEROLD, DAVID MARC (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARC
Last Name:HEROLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2845 PGA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2910
Mailing Address - Country:US
Mailing Address - Phone:561-693-0540
Mailing Address - Fax:561-296-6174
Practice Address - Street 1:600 VILLAGE SQUARE XING
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4543
Practice Address - Country:US
Practice Address - Phone:561-693-0540
Practice Address - Fax:561-296-6174
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME781592085R0203X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257747000Medicaid
FLE2572ZMedicare PIN
FLE2572YMedicare PIN
FL257747000Medicaid