Basic Information
| Provider Information | |||||||||
| NPI: | 1144296609 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERTLER | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 361 OLD BELGRADE RD | ||||||||
| Address2: | ALFOND CANCER CENTER | ||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043308058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076216100 | ||||||||
| FaxNumber: | 2076216102 | ||||||||
| Practice Location | |||||||||
| Address1: | 361 OLD BELGRADE RD | ||||||||
| Address2: | ALFOND CANCER CENTER | ||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043308058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076216100 | ||||||||
| FaxNumber: | 2076216102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 08/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 014334 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 324830099 | 05 | ME | MEDICAID |