Provider Demographics
NPI:1144225780
Name:HERSHKOWITZ, LAURA LYNN (DO)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:HERSHKOWITZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:#408
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4252
Mailing Address - Country:US
Mailing Address - Phone:253-403-0344
Mailing Address - Fax:
Practice Address - Street 1:316 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:#408
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4252
Practice Address - Country:US
Practice Address - Phone:253-403-0344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010193L2084N0402X
WAOP601006852084N0402X, 2084N0400X, 207T00000X, 2084N0008X, 2084A0401X, 2084P0805X, 2084N0600X, 2084P0005X, 2084P0800X, 204D00000X, 2081N0008X
WAOPO60100685204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017328760003Medicaid
PA130022760OtherRAILROAD MEDICARE IND#
PAG64638Medicare UPIN