Provider Demographics
NPI:1003823311
Name:HERMANSEN, KAREN L (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:HERMANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6231 LEESBURG PIKE
Mailing Address - Street 2:500
Mailing Address - City:FALL CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044
Mailing Address - Country:US
Mailing Address - Phone:703-536-2729
Mailing Address - Fax:703-241-0381
Practice Address - Street 1:6231 LEESBURG PIKE
Practice Address - Street 2:500
Practice Address - City:FALL CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044
Practice Address - Country:US
Practice Address - Phone:703-536-2729
Practice Address - Fax:703-241-0381
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101031980207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB93060Medicare UPIN
VA64560Medicare PIN
VA00807E49Medicare PIN