1750473856 NPI number — DR. LAURIE HERSCHER M.D.

Table of content: DR. LAURIE HERSCHER M.D. (NPI 1750473856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750473856 NPI number — DR. LAURIE HERSCHER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERSCHER
Provider First Name:
LAURIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750473856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 418837
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-8837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-309-6765
Provider Business Mailing Address Fax Number:
301-309-2230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11006 VEIRS MILL RD STE L1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEATON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902-2587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-681-4422
Provider Business Practice Location Address Fax Number:
301-681-1684
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  036166890 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 0101232311 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: D0040440 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0344277-00 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21225933862 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2006597 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 434219400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: S357-0003 . This is a "CAREFIRST BC/BS DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 105852 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3040740 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4342194-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2196482 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 613717-01 . This is a "CAREFIRST BC/BS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 530306 . This is a "NATIONAL CAPITOL PPO" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 7782438 . This is a "AETNA PPO/POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0994125001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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