Provider Demographics
NPI:1467466995
Name:HERMANUS, MARVELA GRATIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARVELA
Middle Name:GRATIA
Last Name:HERMANUS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 WORCESTER ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3744
Mailing Address - Country:US
Mailing Address - Phone:617-964-6681
Mailing Address - Fax:339-686-2561
Practice Address - Street 1:888 WORCESTER ST
Practice Address - Street 2:SUITE 130
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-3744
Practice Address - Country:US
Practice Address - Phone:617-964-6681
Practice Address - Fax:339-686-2561
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2209213E00000X
RIDPM00314213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29310-1/412354OtherBLUE CROSS BLUE SHIELD
480031933OtherMEDICARE RAILROAD
MA0322016Medicaid
RIMH48662Medicaid
MAY71109OtherBLUE CROSS BLUE SHIELD
MA0322016Medicaid
RIMH48662Medicaid
U85448Medicare UPIN
MALX5315Medicare PIN