Provider Demographics
NPI:1104837269
Name:HERSHFELD, KAREN DIANA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DIANA
Last Name:HERSHFELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:DIANA
Other - Last Name:KIME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-4597
Mailing Address - Country:US
Mailing Address - Phone:301-533-4000
Mailing Address - Fax:301-533-4208
Practice Address - Street 1:251 N 4TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:301-533-4000
Practice Address - Fax:301-533-4208
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001983363A00000X, 363A00000X
PAMA002947L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1104837269Medicaid
MD144345Y1ZMedicare PIN
MD299439Medicaid
PAP00841524Medicare PIN
MD959MM073Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
MDP00833011Medicare PIN
MDP00725987Medicare PIN