Provider Demographics
NPI:1144221052
Name:HERSH, MARTIN STEPHEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:STEPHEN
Last Name:HERSH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 DAVISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-3337
Mailing Address - Country:US
Mailing Address - Phone:215-659-1610
Mailing Address - Fax:215-830-9830
Practice Address - Street 1:203 DAVISVILLE RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-3337
Practice Address - Country:US
Practice Address - Phone:215-659-1610
Practice Address - Fax:215-830-9830
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002736L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480021938OtherRAILROAD MEDICARE
PA0060597000OtherBLUE CROSS
PA1036123OtherKEYSTONE MERCY
PA00963458Medicaid
HE98400Medicare ID - Type Unspecified
PA1301310001Medicare NSC
PA00963458Medicaid