Healthcare Provider Details

I. General information

NPI: 1548433592
Provider Name (Legal Business Name): LAUREN HERCHAK AYERSMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PLAZA DR SUITE 290
BELLE VERNON PA
15012-4019
US

IV. Provider business mailing address

800 PLAZA DR SUITE 290
BELLE VERNON PA
15012-4019
US

V. Phone/Fax

Practice location:
  • Phone: 724-379-6850
  • Fax: 678-553-0330
Mailing address:
  • Phone: 724-379-6850
  • Fax: 678-553-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS016406
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: