Healthcare Provider Details

I. General information

NPI: 1720351455
Provider Name (Legal Business Name): COLBY NOEL HERMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 09/29/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

8901 WISCONSIN AVE
BETHESDA MD
20889-5600
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-2027
  • Fax:
Mailing address:
  • Phone: 814-715-3084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055369
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: