Provider Demographics
NPI:1306995188
Name:HIRSCH, SARAH L (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-345-5400
Mailing Address - Fax:208-345-5454
Practice Address - Street 1:100 E IDAHO ST STE 300
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6269
Practice Address - Country:US
Practice Address - Phone:208-345-5400
Practice Address - Fax:208-345-5454
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-94622086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20000552Medicare PIN