Healthcare Provider Details

I. General information

NPI: 1457397010
Provider Name (Legal Business Name): JOSEPHINE MARIE HERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON ST NEMC 298
BOSTON MA
02111-1526
US

IV. Provider business mailing address

607 COMMONWEALTH AVE
NEWTON MA
02459-1628
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6044
  • Fax:
Mailing address:
  • Phone: 617-969-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number212782
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: