Provider Demographics
NPI:1689676801
Name:HERTZMAN, MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:HERTZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11404 OLD GEORGETOWN RD
Mailing Address - Street 2:STE 203
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2876
Mailing Address - Country:US
Mailing Address - Phone:301-984-8800
Mailing Address - Fax:301-984-8802
Practice Address - Street 1:11404 OLD GEORGETOWN RD
Practice Address - Street 2:STE 203
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2876
Practice Address - Country:US
Practice Address - Phone:301-984-8800
Practice Address - Fax:301-984-8802
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016115174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0H18OtherBCBS
MD0087611Medicaid
DC23880001OtherBCBS
MD325227OtherMDIPA
MD325227OtherMDIPA
DC23880001OtherBCBS