Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 10855 | MD |
NPI | 1003936345 |
---|---|
Provider Name | Jeffrey A Hirsch |
First Address | Olney, MD 20832 |
Second Address | Olney, MD 20832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 08/07/2007 |