Provider Demographics
NPI:1528113883
Name:HIRSCH, RANELLA (MD)
Entity type:Individual
Prefix:DR
First Name:RANELLA
Middle Name:
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CONCORD AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1053
Mailing Address - Country:US
Mailing Address - Phone:617-868-8685
Mailing Address - Fax:
Practice Address - Street 1:777 CONCORD AVE STE 206
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1053
Practice Address - Country:US
Practice Address - Phone:617-868-8685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216043207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology