Provider Demographics
NPI:1114716248
Name:HIRSH, SUSAN (DC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HIRSH
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14440 CHERRY LANE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4946
Mailing Address - Country:US
Mailing Address - Phone:301-490-7785
Mailing Address - Fax:301-604-8834
Practice Address - Street 1:14440 CHERRY LANE CT STE 100
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4946
Practice Address - Country:US
Practice Address - Phone:301-490-7785
Practice Address - Fax:301-604-8834
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01359111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation