Provider Demographics
NPI:1699734053
Name:HERMAN, CHRISTOPHER MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARTIN
Last Name:HERMAN
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 1:753 JOHNNIE DODDS BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3054
Mailing Address - Country:US
Mailing Address - Phone:843-284-3400
Mailing Address - Fax:843-284-3401
Practice Address - Street 1:8TH AVENUE & C STREET
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-0001
Practice Address - Country:US
Practice Address - Phone:801-408-1823
Practice Address - Fax:801-408-5196
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5632586-1205207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5632586-1205OtherUT MEDICAL LICENSE
TX8J6152Medicare PIN
2001515Medicare ID - Type Unspecified
TX8J4398Medicare PIN
H60374Medicare UPIN