Provider Demographics
NPI:1841211307
Name:HERNANDEZ, PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:HERNANDEZ
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 1:881 COMMONWEALTH AVE
Mailing Address - Street 2:BOSTON UNIVERSITY STUDENT HEALTH SERVICES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1390
Mailing Address - Country:US
Mailing Address - Phone:617-353-9569
Mailing Address - Fax:617-353-1128
Practice Address - Street 1:881 COMMONWEALTH AVE
Practice Address - Street 2:BOSTON UNIVERSITY STUDENT HEALTH SERVICES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1390
Practice Address - Country:US
Practice Address - Phone:617-353-9569
Practice Address - Fax:617-353-1128
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA765422084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F72933Medicare UPIN