Provider Demographics
NPI:1881786432
Name:HERZING, THOMAS J (PA-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:HERZING
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-4024
Mailing Address - Fax:814-372-2579
Practice Address - Street 1:20 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3842
Practice Address - Country:US
Practice Address - Phone:814-375-6072
Practice Address - Fax:814-503-8750
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA000621L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS34837Medicare UPIN
PA391013Medicare PIN