Provider Demographics
NPI:1447450937
Name:HERNANDEZ-GONZALEZ, ANDREA (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:HERNANDEZ-GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 751069
Mailing Address - Street 2:ECU SCHOOL OF MEDICINE
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7225
Mailing Address - Country:US
Mailing Address - Phone:252-744-3258
Mailing Address - Fax:
Practice Address - Street 1:905 JOHNS HOPKINS DRIVE
Practice Address - Street 2:ECU PHYSICIANS PSYCHIATRIC MEDICINE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7225
Practice Address - Country:US
Practice Address - Phone:252-744-1406
Practice Address - Fax:252-744-4243
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-007862084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911875Medicaid
NC154K4OtherBCBS NC
NC5911875Medicaid