Provider Demographics
NPI:1255344321
Name:KNOX, A.E. HERTZLER (MD)
Entity type:Individual
Prefix:DR
First Name:A.E. HERTZLER
Middle Name:
Last Name:KNOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PROHEALTH PHYSICIANS OF BRISTOL
Mailing Address - Street 2:1251 FARMINGTON AVE.
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:860-584-4535
Mailing Address - Fax:860-589-7656
Practice Address - Street 1:PROHEALTH PHYSICIANS OF BRISTOL
Practice Address - Street 2:1251 FARMINGTON AVE.
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-584-4535
Practice Address - Fax:860-589-7656
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE05319Medicare UPIN