Provider Demographics
NPI:1508146028
Name:PEDRO HERNANDEZ HERNANDEZ SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:PEDRO HERNANDEZ HERNANDEZ SURGICAL ASSOCIATES
Other - Org Name:HERNANDEZ SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-487-1077
Mailing Address - Street 1:936 CIRCLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-4526
Mailing Address - Country:US
Mailing Address - Phone:910-582-3761
Mailing Address - Fax:910-582-3827
Practice Address - Street 1:936 CIRCLEWOOD DR
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4526
Practice Address - Country:US
Practice Address - Phone:910-582-3761
Practice Address - Fax:910-582-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty