Individual
JAMES KENNETH HERSTOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
75 GIBBS AVE, NEWPORT, RI 02840-2216
(401) 849-2223
Mailing address
75 GIBBS AVE, NEWPORT, RI 02840-2216
(401) 849-2223
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD04667
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000709
BLUE CROSS BLUE SHIELD RI
RI
05
—
900709
—
RI
Enumeration date
05/25/2005
Last updated
12/03/2007
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