Provider Demographics
NPI:1932279163
Name:HERSHKOWITZ, DOUGLAS MARK (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MARK
Last Name:HERSHKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3195 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6729
Mailing Address - Country:US
Mailing Address - Phone:941-625-0600
Mailing Address - Fax:941-624-0941
Practice Address - Street 1:517 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5520
Practice Address - Country:US
Practice Address - Phone:941-625-0600
Practice Address - Fax:941-624-0941
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85239207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62924OtherBCBS OF FLORIDA
FL62924OtherBCBS OF FLORIDA
FLE8016YMedicare PIN