Provider Demographics
NPI:1578827077
Name:VERMAIRE, HOPE MARIAN (DO)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:MARIAN
Last Name:VERMAIRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 ADMIRALTY WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5424
Mailing Address - Country:US
Mailing Address - Phone:310-694-5255
Mailing Address - Fax:310-306-5555
Practice Address - Street 1:4560 ADMIRALTY WAY STE 105
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5424
Practice Address - Country:US
Practice Address - Phone:310-694-5255
Practice Address - Fax:310-306-5555
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020058207V00000X
ORDO175806207V00000X
CAA16705207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500711497Medicaid
OR161133OtherNORTH BEND MEDICAL CENTER GROUP MEDICAID
ORR0000WFBTVOtherNORTH BEND MEDICAL CENTER GROUP MEDICARE
OR1407812365OtherNORTH BEND MEDICAL CENTER GROUP NPI
OR93-0635514OtherNORTH BEND MEDICAL CENTER GROUP TAX ID
ORR189285Medicare PIN