Provider Demographics
NPI:1700923059
Name:HIRSCH, CECILIA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:MARIA
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 15TH STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631
Mailing Address - Country:US
Mailing Address - Phone:970-392-0900
Mailing Address - Fax:970-506-3785
Practice Address - Street 1:1800 15TH ST STE 310
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4562
Practice Address - Country:US
Practice Address - Phone:970-392-0900
Practice Address - Fax:970-506-3795
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43791207R00000X, 207RC0000X
CODR-43791390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85103268Medicaid
COCO305323Medicare PIN