Provider Demographics
NPI:1144214784
Name:HERMES, MARJORIE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANNE
Last Name:HERMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:ANNE
Other - Last Name:LIESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3650 JOSEPH SIEWICK DR
Mailing Address - Street 2:STE 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1710
Mailing Address - Country:US
Mailing Address - Phone:703-391-2020
Mailing Address - Fax:703-391-1211
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:STE 400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1710
Practice Address - Country:US
Practice Address - Phone:703-391-2020
Practice Address - Fax:703-391-1211
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA05604613Medicaid
VA080182893OtherRR MEDICARE
E62991Medicare UPIN
VA05604613Medicaid