Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 00972 | MD |
N | 103T00000X | Psychologist | 00972 | MD |
N | 103G00000X | Clinical Psychologist | 000972 | MD |
N | 103TC0700X | Clinical Psychologist | 000972 | MD |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 00972 | MD |
N | 103TF0000X | Family Psychologist | 00972 | MD |
N | 103TP2701X | Group Psychotherapist | 00972 | MD |
NPI | 1053539924 |
---|---|
Provider Name | Dr. Marc Andrew Nemiroff |
First Address | Potomac, MD 20854-6209 |
Second Address | Potomac, MD 20854-6209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00972 | 972 (01) | MD |
0810000767 | 0810000767 (01) | VA |
PSY812 | 812 (01) | DC |