Basic Information
| Provider Information | |||||||||
| NPI: | 1609841394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MILTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 300 MEDICAL PKWY STE 120 | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572525660 | ||||||||
| FaxNumber: | 7575489443 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MEDICAL PKWY STE 120 | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233204985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572525660 | ||||||||
| FaxNumber: | 7575489443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101035430 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RA0001X | 0101035430 | VA | Y |
ID Information
| ID | Type | State | Issuer | Description | 006000509 | 05 | VA | MEDICAID | 15792 | 01 | VA | SENTARA OHP/SHP | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | -001 | 01 | VA | TRICARE/CHAMPUS | OTHER | 006040802 | 05 | VA | MEDICAID | 050275 | 01 | VA | ANTHEM | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 250147 | 01 | VA | ANTHEM | OTHER | PAR | 01 | VA | CIGNA | OTHER | 0513M | 01 | VA | BC/BS NC | OTHER | PAR | 01 | VA | AETNA | OTHER | 890513M | 05 | NC | MEDICAID | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | 15601 | 01 | VA | OPTIMA | OTHER | 249503 | 01 | VA | MAMSI | OTHER | 263654 | 01 | VA | UHC/MAMSI | OTHER |