Provider Demographics
NPI:1548223837
Name:HIRSHON, JON MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JON MARK
Middle Name:
Last Name:HIRSHON
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 1:1062 RIVER BAY RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-4830
Mailing Address - Country:US
Mailing Address - Phone:410-074-0661
Mailing Address - Fax:410-974-0819
Practice Address - Street 1:10 S GREENE ST
Practice Address - Street 2:UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044264207P00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD91WWMedicare PIN
MDF66196Medicare UPIN
MDH254UNMedicare PIN