Provider Demographics
NPI:1508834995
Name:BERGHAHN, LAURA J (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:BERGHAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 REGENT STREET
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705
Mailing Address - Country:US
Mailing Address - Phone:608-233-9746
Mailing Address - Fax:608-233-0026
Practice Address - Street 1:4410 REGENT STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705
Practice Address - Country:US
Practice Address - Phone:608-233-9746
Practice Address - Fax:608-233-0026
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41303207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology