MEDICARE: ALEX TODD HIRSH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	35080967	OH

General Provider Information

NPI Number	:	1174639181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX TODD HIRSH M.D.

Provider Business Mailing Address
First Line	:	6551 WILSON MILLS RD
Second Line	:	SUITE 101
City	:	CLEVELAND
State	:	OH
Zip	:	44143-3495
Country	:	US
Telephone Number	:	440-460-2884
Fax Number	:	440-460-2885

Provider Business Practice Location Address
First Line	:	6551 WILSON MILLS RD
Second Line	:	SUITE 101
City	:	CLEVELAND
State	:	OH
Zip	:	44143-3495
Country	:	US
Telephone Number	:	440-460-2884
Fax Number	:	440-460-2885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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