MEDICARE: HERNANDO JIMENEZ M.D.

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	207ZN0500X	Neuropathology Physician	10129	WV
2	207ZP0101X	Anatomic Pathology Physician	10129	WV
3	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	0101022951	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220021414	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285634113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERNANDO JIMENEZ M.D.

Provider Business Mailing Address
First Line	:	4700 BERWYN HOUSE RD STE 208
Second Line	:	COLLEGE PARK
City	:	COLLEGE PARK
State	:	MD
Zip	:	20740-4719
Country	:	US
Telephone Number	:	301-220-0150
Fax Number	:	301-220-1032

Provider Business Practice Location Address
First Line	:	2500 HOSPITAL DRIVE
Second Line	:	CITY HOSPITAL
City	:	MARTINSBURG
State	:	WV
Zip	:	25401
Country	:	US
Telephone Number	:	304-264-1212
Fax Number	:	304-264-0135

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	04/01/2008

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Directions to “ HERNANDO JIMENEZ M.D.” Practice Location

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