MEDICARE: LAURA LYNN HERSHKOWITZ D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	OS010193L	PA
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	OP60100685	WA
3	2084N0400X	Neurology Physician	OP60100685	WA
4	207T00000X	Neurological Surgery Physician	OP60100685	WA
5	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	OP60100685	WA
6	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	OP60100685	WA
7	2084P0805X	Geriatric Psychiatry Physician	OP60100685	WA
8	2084N0600X	Clinical Neurophysiology Physician	OP60100685	WA
9	2084P0005X	Neurodevelopmental Disabilities Physician	OP60100685	WA
10	2084P0800X	Psychiatry Physician	OP60100685	WA
11	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	OP60100685	WA
12	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	OPO60100685	WA
13	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician	OP60100685	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	130022760	OTHER	PA	RAILROAD MEDICARE IND#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144225780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LYNN HERSHKOWITZ D.O.

Provider Business Mailing Address
First Line	:	316 MARTIN LUTHER KING JR WAY
Second Line	:	#408
City	:	TACOMA
State	:	WA
Zip	:	98405-4252
Country	:	US
Telephone Number	:	253-403-0344
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 MARTIN LUTHER KING JR WAY
Second Line	:	#408
City	:	TACOMA
State	:	WA
Zip	:	98405-4252
Country	:	US
Telephone Number	:	253-403-0344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	09/22/2011

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