Provider Demographics
NPI:1487696324
Name:HERSH, EVA S (MD)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:S
Last Name:HERSH
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 1:3251 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8506
Mailing Address - Country:US
Mailing Address - Phone:727-321-3854
Mailing Address - Fax:
Practice Address - Street 1:3251 3RD AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8506
Practice Address - Country:US
Practice Address - Phone:727-321-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5620101OtherAETNA HMP
MDX697-0006OtherCAREFIRST DC
3318973OtherCIGNA
031733OtherJHHC PRODUCTS
MD8500613OtherAETNA PPO
314709OtherKAISER
MD211461500Medicaid
MDCB6XPAOtherCAREFIRST MD
MDX697-0006OtherCAREFIRST DC
MDD71535Medicare UPIN