Provider Demographics
NPI:1467641787
Name:HIRSCH, DAVID I (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:I
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:P.O. BOX 6000
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704
Mailing Address - Country:US
Mailing Address - Phone:662-335-4105
Mailing Address - Fax:662-378-2879
Practice Address - Street 1:220 N. PEARMAN
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732
Practice Address - Country:US
Practice Address - Phone:662-846-6943
Practice Address - Fax:662-843-8956
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11895174400000X, 207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018713Medicaid
390000019Medicare PIN