Healthcare Provider Details

I. General information

NPI: 1275520363
Provider Name (Legal Business Name): JOANNE HERRMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8324 PROFESSIONAL HILL DR
FAIRFAX VA
22031-4611
US

IV. Provider business mailing address

6035 BURKE CENTRE PKWY #390
BURKE VA
22015-3750
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-5600
  • Fax: 703-573-5665
Mailing address:
  • Phone: 703-978-1196
  • Fax: 703-978-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101034076
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: