Healthcare Provider Details

I. General information

NPI: 1578628467
Provider Name (Legal Business Name): ANTHONY DOUGLAS HIRTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON RD CREDENTIAL'S OFFICE, KELLER ARMY COMMUNITY HOSPITAL
WEST POINT NY
10996-1109
US

IV. Provider business mailing address

900 WASHINGTON RD CREDENTIAL'S OFFICE, KELLER ARMY COMMUNITY HOSPITAL
WEST POINT NY
10996-1109
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-4114
  • Fax:
Mailing address:
  • Phone: 845-938-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101053288
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: