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General NPI Number Information
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NPI Number | 1114095775
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Entity Type | Organization
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Legal Business Name | FRED S HIRSH MD INC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 6551 WILSON MILLS RD SUITE 101
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City | CLEVELAND
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State | OH
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Zip | 44143-3495
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Country | US
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Telephone | 440-460-2884
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Fax | 440-460-2885
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Provider Business Mailing Address
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Address Line | 6551 WILSON MILLS RD SUITE 101
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City | CLEVELAND
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State | OH
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Zip | 44143-3495
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Country | US
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Telephone | 440-460-2884
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Fax | 440-460-2885
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Authorized Official
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Title or Position | TIN OWNER
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Name | DR. ALEX TODD HIRSH
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Credential | M.D.
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Telephone | 440-460-2884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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