Healthcare Provider Details

I. General information

NPI: 1750594578
Provider Name (Legal Business Name): MARGERY HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 YORK RD SUITE 200
TIMONIUM MD
21093-2266
US

IV. Provider business mailing address

2326 YORK RD SUITE 200
TIMONIUM MD
21093-2266
US

V. Phone/Fax

Practice location:
  • Phone: 410-828-5699
  • Fax: 410-828-0711
Mailing address:
  • Phone: 410-828-5699
  • Fax: 410-828-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10634
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: