Provider Demographics
NPI:1053400630
Name:HERPEN, ROBERT W (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:HERPEN
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 1:8TH AT RACE ST
Mailing Address - Street 2:TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2496
Mailing Address - Country:US
Mailing Address - Phone:215-625-5215
Mailing Address - Fax:215-625-9837
Practice Address - Street 1:8TH AT RACE ST
Practice Address - Street 2:TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2496
Practice Address - Country:US
Practice Address - Phone:215-625-5215
Practice Address - Fax:215-625-9837
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC02238L213EP1101X, 213ES0131X
PASC 002238 L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008776180001Medicaid
PA000155834OtherHIGHMARK BLUE SHIELD
PA0060717000OtherINDEPENDENCE BLUE CROSS
PA155834G6GMedicare PIN
PA0008776180001Medicaid