Provider Demographics
NPI:1629026240
Name:HIRSCHHORN, MARK K (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:K
Last Name:HIRSCHHORN
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 1:24 W COLE RD
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9404
Mailing Address - Country:US
Mailing Address - Phone:207-283-1602
Mailing Address - Fax:207-282-6835
Practice Address - Street 1:24 W COLE RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9404
Practice Address - Country:US
Practice Address - Phone:207-283-1602
Practice Address - Fax:207-282-6835
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEG09146Medicare UPIN
MEMM7494Medicare ID - Type Unspecified