Provider Demographics
NPI:1184651176
Name:HERMENEGILDO, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HERMENEGILDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 PRESIDENT AVE
Mailing Address - Street 2:SUITE 3002
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5923
Mailing Address - Country:US
Mailing Address - Phone:508-676-3411
Mailing Address - Fax:508-676-0932
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 3002
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-676-3411
Practice Address - Fax:508-676-0932
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA158476208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
409760OtherBLUE CHIP
793771OtherTUFTS
MAJ19396OtherBLUE CROSS BLUE SHIELD
RIJH45499Medicaid
MA3185591Medicaid
MAAA49773OtherHARVARD PILGRIM HC
7590960OtherCIGNA
MA000000031922OtherBMC
0026789OtherNHP
MA003457OtherSWH
1152759OtherAETNA
MAJ19396OtherBLUE CROSS BLUE SHIELD
MAA28754Medicare PIN