Provider Demographics
NPI:1982663563
Name:HIRSCH, JO ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JO ELLEN
Middle Name:
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5567 WHITHORN CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-0237
Mailing Address - Country:US
Mailing Address - Phone:910-482-3078
Mailing Address - Fax:910-488-1061
Practice Address - Street 1:BLDG M-4861 LOGISTICS AVE
Practice Address - Street 2:JOEL HEALTH CLINIC
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-9213
Practice Address - Fax:910-907-9828
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H44433Medicare UPIN