Individual
HERNANDO JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 HOSPITAL DRIVE, CITY HOSPITAL, MARTINSBURG, WV 25401
(304) 264-1212
(304) 264-0135
Mailing address
4700 BERWYN HOUSE RD STE 208, COLLEGE PARK, COLLEGE PARK, MD 20740-4719
(301) 220-0150
(301) 220-1032
Taxonomy
Speciality
Code
Description
License number
State
207ZN0500X
Neuropathology Physician
Primary
10129
WV
207ZP0101X
Anatomic Pathology Physician
10129
WV
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
0101022951
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101738000
—
WV
01
—
220021414
RAILROAD MEDICARE
WV
Enumeration date
07/21/2005
Last updated
04/01/2008
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