Provider Demographics
NPI:1336243419
Name:HERSKOWITZ, AHVIE (MD)
Entity Type:Individual
Prefix:DR
First Name:AHVIE
Middle Name:
Last Name:HERSKOWITZ
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 1:2058 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1306
Mailing Address - Country:US
Mailing Address - Phone:415-759-8150
Mailing Address - Fax:415-759-8161
Practice Address - Street 1:2058 12TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1306
Practice Address - Country:US
Practice Address - Phone:415-759-8150
Practice Address - Fax:415-759-8161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC050117207R00000X, 207RC0000X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease