Provider Demographics
NPI:1518923713
Name:HIRSCHKORN, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HIRSCHKORN
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 1:444 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1969
Mailing Address - Country:US
Mailing Address - Phone:413-594-3111
Mailing Address - Fax:413-789-8047
Practice Address - Street 1:444 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1969
Practice Address - Country:US
Practice Address - Phone:413-594-3111
Practice Address - Fax:413-789-8047
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53604207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6184006Medicaid
MAA51474Medicare UPIN
MA6184006Medicaid