Provider Demographics
NPI: | 1144225780 |
---|---|
Name: | HERSHKOWITZ, LAURA LYNN (DO) |
Entity Type: | Individual |
Prefix: | |
First Name: | LAURA |
Middle Name: | LYNN |
Last Name: | HERSHKOWITZ |
Suffix: | |
Gender: | F |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 316 MARTIN LUTHER KING JR WAY |
Mailing Address - Street 2: | #408 |
Mailing Address - City: | TACOMA |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98405-4252 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 253-403-0344 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 316 MARTIN LUTHER KING JR WAY |
Practice Address - Street 2: | #408 |
Practice Address - City: | TACOMA |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98405-4252 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-403-0344 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-20 |
Last Update Date: | 2011-09-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | OS010193L | 2084N0402X |
WA | OP60100685 | 2084N0402X, 2084N0400X, 207T00000X, 2084N0008X, 2084A0401X, 2084P0805X, 2084N0600X, 2084P0005X, 2084P0800X, 204D00000X, 2081N0008X |
WA | OPO60100685 | 204C00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084N0600X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology |
No | 2084N0402X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | |
No | 2084N0008X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neuromuscular Medicine |
No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine |
No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
No | 2084P0005X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurodevelopmental Disabilities |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No | 204D00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | |
No | 204C00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | |
No | 2081N0008X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Neuromuscular Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 0017328760003 | Medicaid | |
PA | 130022760 | Other | RAILROAD MEDICARE IND# |
PA | G64638 | Medicare UPIN |