Healthcare Provider Details

I. General information

NPI: 1891302402
Provider Name (Legal Business Name): EVERARDO HERNANDEZ QUINTELA MD, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-7450
  • Fax: 410-614-9172
Mailing address:
  • Phone: 410-933-2704
  • Fax: 410-614-9172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD48438
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberD48438
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: