Provider Demographics
NPI:1477636892
Name:HIRSH, SCOTT D (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:HIRSH
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:PO BOX 22958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0958
Mailing Address - Country:US
Mailing Address - Phone:216-595-9600
Mailing Address - Fax:
Practice Address - Street 1:6770 MAYFIELD RD
Practice Address - Street 2:SUITE 323
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-449-5782
Practice Address - Fax:440-449-7311
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003304H213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2451109Medicaid
OH2451109Medicaid