Provider Demographics
NPI:1972728202
Name:HERSHBERGER, DARYL L (MD)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:L
Last Name:HERSHBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-1147
Mailing Address - Country:US
Mailing Address - Phone:260-463-2468
Mailing Address - Fax:260-463-4237
Practice Address - Street 1:2120 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-1147
Practice Address - Country:US
Practice Address - Phone:260-463-2468
Practice Address - Fax:260-463-4237
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037748A207Q00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN8757OtherPHP
IN000000299462OtherANTHEM BCBS
IN100159830AMedicaid
IN153823Medicare Oscar/Certification
IN100159830AMedicaid
IN000000299462OtherANTHEM BCBS