Provider Demographics
NPI:1902872245
Name:HERBST, MICHAEL H (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:HERBST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 KNOWLES AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2428
Mailing Address - Country:US
Mailing Address - Phone:301-942-8110
Mailing Address - Fax:301-942-8530
Practice Address - Street 1:3930 KNOWLES AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2428
Practice Address - Country:US
Practice Address - Phone:301-942-8110
Practice Address - Fax:301-942-8530
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00404213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT30895Medicare UPIN
175857Medicare ID - Type UnspecifiedMEDICARE ID #
MD0664530001Medicare NSC