Provider Demographics
NPI:1659559714
Name:FERNANDO MD & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FERNANDO MD & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:M CORAZON
Authorized Official - Middle Name:G
Authorized Official - Last Name:FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-239-0320
Mailing Address - Street 1:231 N SHIPPEN ST
Mailing Address - Street 2:UNIT 21B
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2770
Mailing Address - Country:US
Mailing Address - Phone:717-239-0320
Mailing Address - Fax:717-238-0322
Practice Address - Street 1:231 N SHIPPEN ST
Practice Address - Street 2:UNIT 21B
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2770
Practice Address - Country:US
Practice Address - Phone:717-239-0320
Practice Address - Fax:717-238-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032055E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA121742Medicare PIN