Provider Demographics
NPI:1669646899
Name:ERNEST D. HANOWELL MD PC
Entity Type:Organization
Organization Name:ERNEST D. HANOWELL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:D
Authorized Official - Last Name:HANOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-897-5450
Mailing Address - Street 1:10215 FERNWOOD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1299
Mailing Address - Country:US
Mailing Address - Phone:301-897-5450
Mailing Address - Fax:
Practice Address - Street 1:10215 FERNWOOD RD STE 102
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1299
Practice Address - Country:US
Practice Address - Phone:301-897-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21898208600000X
208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3666514000Medicaid
MD1952381428OtherINDIVIDUAL NPI