Provider Demographics
NPI:1053539924
Name:NEMIROFF, MARC ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANDREW
Last Name:NEMIROFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8513 AQUEDUCT RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-6209
Mailing Address - Country:US
Mailing Address - Phone:301-294-0032
Mailing Address - Fax:301-294-1162
Practice Address - Street 1:8513 AQUEDUCT RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-6209
Practice Address - Country:US
Practice Address - Phone:301-294-0032
Practice Address - Fax:301-294-1162
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00972103T00000X, 103TC2200X, 103TF0000X, 103TP2701X
MD000972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00972Other972
DCPSY812Other812
VA0810000767Other0810000767
DCPSY812Other812