Basic Information
| Provider Information | |||||||||
| NPI: | 1184651176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERMENEGILDO | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1030 PRESIDENT AVE | ||||||||
| Address2: | SUITE 3002 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027205923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763411 | ||||||||
| FaxNumber: | 5086760932 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 PRESIDENT AVE | ||||||||
| Address2: | SUITE 3002 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027205923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763411 | ||||||||
| FaxNumber: | 5086760932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 09/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MA158476 | MA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 409760 | 01 | BLUE CHIP | OTHER | 793771 | 01 | TUFTS | OTHER | J19396 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | JH45499 | 05 | RI | MEDICAID | 3185591 | 05 | MA | MEDICAID | AA49773 | 01 | MA | HARVARD PILGRIM HC | OTHER | 7590960 | 01 | CIGNA | OTHER | 000000031922 | 01 | MA | BMC | OTHER | 0026789 | 01 | NHP | OTHER | 003457 | 01 | MA | SWH | OTHER | 1152759 | 01 | AETNA | OTHER |