Provider Demographics
NPI:1043387715
Name:DRS.FERNANDEZ AND SRIPRASERT P.A.
Entity Type:Organization
Organization Name:DRS.FERNANDEZ AND SRIPRASERT P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-868-8200
Mailing Address - Street 1:7700 OLD BRANCH AVE
Mailing Address - Street 2:SUITE C102
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1628
Mailing Address - Country:US
Mailing Address - Phone:301-868-8200
Mailing Address - Fax:301-868-6776
Practice Address - Street 1:7700 OLD BRANCH AVE
Practice Address - Street 2:SUITE C102
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1628
Practice Address - Country:US
Practice Address - Phone:301-868-8200
Practice Address - Fax:301-868-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0006OtherCAREFIRST BLUESHIELD
DC165600Medicare PIN