Provider Demographics
NPI:1841431343
Name:TELLES-HERNANDEZ, LUIS (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:TELLES-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 1:9111 EDMONSTON RD STE 206
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1546
Mailing Address - Country:US
Mailing Address - Phone:301-664-2657
Mailing Address - Fax:301-664-2746
Practice Address - Street 1:9111 EDMONSTON RD STE 206
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1546
Practice Address - Country:US
Practice Address - Phone:301-664-2657
Practice Address - Fax:301-664-2746
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD91595208VP0014X, 207L00000X, 207LP2900X
MDC0003945363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical