Provider Demographics
NPI:1619041993
Name:TOMAS J HERNANDEZ MD
Entity Type:Organization
Organization Name:TOMAS J HERNANDEZ MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-345-4465
Mailing Address - Street 1:7525 GREENWAY CENTER DRIVE
Mailing Address - Street 2:SUITE T6
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-345-4465
Mailing Address - Fax:301-345-7797
Practice Address - Street 1:7525 GREENWAY CENTER DRIVE
Practice Address - Street 2:SUITE T6
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-345-4465
Practice Address - Fax:301-345-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD08520207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C4210001OtherCAREFIRST
45487OtherMAMSI
063765Medicare ID - Type Unspecified
MDD09295Medicare UPIN