MEDICARE: MARCO ANTONIO HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		DE

General Provider Information

NPI Number	:	1093631186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCO ANTONIO HERNANDEZ

Provider Business Mailing Address
First Line	:	107 WASHINGTON ST
Second Line	:
City	:	LAUREL
State	:	DE
Zip	:	19956-1155
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 CAPITOL TRL
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19711-5709
Country	:	US
Telephone Number	:	302-344-9264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2026
Last Update Date	:	06/24/2026

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Directions to “ MARCO ANTONIO HERNANDEZ ” Practice Location

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