Basic Information
| Provider Information | |||||||||
| NPI: | 1568468924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERCEG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 779 | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261020779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044222523 | ||||||||
| FaxNumber: | 3044854466 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 GARFIELD AVE | ||||||||
| Address2: | STE 205 | ||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261015444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044222523 | ||||||||
| FaxNumber: | 3044854466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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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 | 207ZP0102X | 19343 | WV | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.