Healthcare Provider Details

I. General information

NPI: 1649327628
Provider Name (Legal Business Name): JOHN A HERMANN JR. CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E UNIVERSITY PKWY
BALTIMORE MD
21218-2829
US

IV. Provider business mailing address

890 DIXON RD
FRIENDSVILLE MD
21531-1530
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR137796
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: