Provider Demographics
NPI:1558411751
Name:HERPEL, LAURA BOGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:BOGAN
Last Name:HERPEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ALYSON
Other - Last Name:BOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1333 TAYLOR ST STE 6B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2953
Mailing Address - Country:US
Mailing Address - Phone:803-251-3093
Mailing Address - Fax:803-376-1876
Practice Address - Street 1:1333 TAYLOR ST STE 6B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2953
Practice Address - Country:US
Practice Address - Phone:803-251-3093
Practice Address - Fax:803-376-1876
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30343207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC303433Medicaid
MD404746000Medicaid
MD404746000Medicaid
MDI05259Medicare UPIN