Provider Demographics
NPI:1245235829
Name:HERMAN, ALYSA ROBIN (MD)
Entity Type:Individual
Prefix:
First Name:ALYSA
Middle Name:ROBIN
Last Name:HERMAN
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 1:135 SAN LORENZO AVENUE
Mailing Address - Street 2:S.700
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-444-4979
Mailing Address - Fax:305-444-4978
Practice Address - Street 1:135 SAN LORENZO AVENUE
Practice Address - Street 2:S.700
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146
Practice Address - Country:US
Practice Address - Phone:305-444-4979
Practice Address - Fax:305-444-4978
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME89408207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI07448Medicare UPIN
FL46015ZMedicare PIN