Provider Demographics
NPI:1285845065
Name:HIRSCH, GLENN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:DAVID
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 TOWNES LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-2330
Mailing Address - Country:US
Mailing Address - Phone:512-680-3764
Mailing Address - Fax:512-708-9387
Practice Address - Street 1:4111 MARATHON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3719
Practice Address - Country:US
Practice Address - Phone:512-302-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE92342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry