Provider Demographics
NPI:1952547515
Name:HERRMANN, MARCIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:E
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EXETER ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2808
Mailing Address - Country:US
Mailing Address - Phone:617-527-1215
Mailing Address - Fax:617-332-0620
Practice Address - Street 1:111 EXETER ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2808
Practice Address - Country:US
Practice Address - Phone:617-527-1215
Practice Address - Fax:617-332-0620
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48794208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics