Provider Demographics
NPI:1275568008
Name:HIRSCH, PETER B (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 WILSHIRE BLVD
Mailing Address - Street 2:202
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2337
Mailing Address - Country:US
Mailing Address - Phone:310-630-3717
Mailing Address - Fax:310-451-1244
Practice Address - Street 1:3201 WILSHIRE BLVD
Practice Address - Street 2:202
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2337
Practice Address - Country:US
Practice Address - Phone:310-630-3717
Practice Address - Fax:310-451-1244
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37940174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91949Medicare UPIN