Provider Demographics
NPI:1932184173
Name:HERSCH, STEVEN M (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:HERSCH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:114 16TH STREET
Mailing Address - Street 2:MGH EAST, BLDG. 114, SUITE 2001
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-4404
Mailing Address - Country:US
Mailing Address - Phone:617-726-1254
Mailing Address - Fax:617-726-1254
Practice Address - Street 1:MASS GENERAL HOSPITAL, WACC
Practice Address - Street 2:SUITE 835
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-1254
Practice Address - Fax:617-724-1480
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2102002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA32447Medicaid
D45642Medicare UPIN
MAA32447Medicaid