Provider Demographics
NPI:1982246377
Name:HIRT, PENELOPE ALEXANDRA (MD)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:ALEXANDRA
Last Name:HIRT
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 1:20890 NE 31ST PL
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3638
Mailing Address - Country:US
Mailing Address - Phone:786-830-5866
Mailing Address - Fax:
Practice Address - Street 1:18801 NE 29TH AVE
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2826
Practice Address - Country:US
Practice Address - Phone:754-544-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162707207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology