Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 30-014094 | OH |
NPI | 1386605152 |
---|---|
Provider Name | Dr. Stanley A Hirsch |
First Address | North Olmsted, OH 44070-6325 |
Second Address | Mayfield Heights, OH 44124-4114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 24/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000115378 | ANTHEM (01) | OH |
1100582 | UNITED HEALTHCARE (01) | OH |
11649450001 | (05) | WY |