MEDICARE: RICHARD D FERNANDEZ MD

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	207ZB0001X	Blood Banking & Transfusion Medicine Physician	ME004673	FL
2	207ZC0500X	Cytopathology Physician	ME004673	FL
3	207ZH0000X	Hematology (Pathology) Physician	ME004673	FL
4	207ZI0100X	Immunopathology Physician	ME0046703	FL
5	207ZP0101X	Anatomic Pathology Physician	ME004673	FL
6	207ZM0300X	Medical Microbiology Physician	ME0046703	FL
7	207ZP0104X	Chemical Pathology Physician	ME004673	FL
8	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	78559	GA
9	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME004673	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00745220	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4122532	OTHER	FL	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	L9266	OTHER	FL	BCBS FL
6	79997	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1558351437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD D FERNANDEZ MD

Provider Business Mailing Address
First Line	:	311 WEST 8TH STREET
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165
Country	:	US
Telephone Number	:	706-291-8702
Fax Number	:	706-291-6514

Provider Business Practice Location Address
First Line	:	311 WEST 8TH STREET
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165
Country	:	US
Telephone Number	:	706-291-8702
Fax Number	:	706-291-6514

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	10/14/2019

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