Provider Demographics
NPI:1952381428
Name:HANOWELL, ERNEST DALTON
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:DALTON
Last Name:HANOWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ERNEST
Other - Middle Name:DALTON
Other - Last Name:HANOWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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:301-493-0213
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:301-493-0213
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21898208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD366651400Medicaid
MD321161400Medicaid
DC021688T08Medicare PIN