Provider Demographics
NPI:1326045501
Name:HIRSH, PAUL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:HIRSH
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 1:219 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5516
Mailing Address - Country:US
Mailing Address - Phone:484-842-1972
Mailing Address - Fax:484-842-1972
Practice Address - Street 1:219 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5516
Practice Address - Country:US
Practice Address - Phone:484-842-1972
Practice Address - Fax:484-842-1972
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033129E207RC0000X
OH35-04-0962207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00954002OtherMEDICARE PTAN
KY0369003OtherMEDICARE
KYP00912944OtherRAILROAD MEDICARE
KY0369203OtherMEDICARE
060036836OtherRAILROAD MEDICARE
KY50024707OtherPASSPORT MEDICAID
KYP00727051OtherRAILROAD MEDICARE PTAN
KY0562607OtherMEDICARE
KY64284748Medicaid
OH0890951Medicaid
OH611300608068OtherCARESOURCE
KY00954002OtherMEDICARE PTAN
KY64284748Medicaid
OH0724566Medicare PIN
OH0724565Medicare PIN
KY0562607OtherMEDICARE
C27756Medicare UPIN
OH0724567Medicare PIN
KYP00912944OtherRAILROAD MEDICARE
KY50024707OtherPASSPORT MEDICAID