MEDICARE: DR. AHVIE HERSKOWITZ M.D.

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	207R00000X	Internal Medicine Physician	C050117	CA
2	207RC0000X	Cardiovascular Disease Physician	C050117	CA
3	207ZP0101X	Anatomic Pathology Physician	C050117	CA

General Provider Information

NPI Number	:	1336243419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHVIE HERSKOWITZ M.D.

Provider Business Mailing Address
First Line	:	2058 12TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1306
Country	:	US
Telephone Number	:	415-759-8150
Fax Number	:	415-759-8161

Provider Business Practice Location Address
First Line	:	2058 12TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1306
Country	:	US
Telephone Number	:	415-759-8150
Fax Number	:	415-759-8161

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	11/25/2014

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