Individual
WILLIAM R HERZOG JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10710 CHARTER DR, SUITE 400, COLUMBIA, MD 21044-2858
(410) 997-7979
(410) 997-9231
Mailing address
10710 CHARTER DR, SUITE 400, COLUMBIA, MD 21044-2858
(410) 997-7979
(410) 997-9231
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
D41959
MD
207RI0011X
Interventional Cardiology Physician
Primary
D41959
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0061936
AETNA
MD
01
—
523202-06
CAREFIRST OF MARYLAND
MD
05
—
543951500
—
MD
01
—
P00963606
RAILROAD MEDICARE
MD
01
—
V879-0001
CAREFIRST GHMSI AND BLUE CHOICE
MD
Enumeration date
03/08/2006
Last updated
02/10/2017
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