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Individual

DR. KEITH D HERZOG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3601 A ST, PHILADELPHIA, PA 19134-1043
(215) 427-6827
(215) 427-5371
Mailing address
3601 A ST., 1-102, PHILADELPHIA, PA 19134-1095
(215) 427-6827
(215) 427-5371

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD038603E
PA
2080P0208X
Pediatric Infectious Diseases Physician
MD038603E
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001243961-0008
PA
Enumeration date
07/10/2006
Last updated
03/26/2014
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