Provider Demographics
NPI:1154412450
Name:HERMANSEN, ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:HERMANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21636-1126
Mailing Address - Country:US
Mailing Address - Phone:410-634-2380
Mailing Address - Fax:833-908-2287
Practice Address - Street 1:316 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:MD
Practice Address - Zip Code:21636-1126
Practice Address - Country:US
Practice Address - Phone:410-634-2380
Practice Address - Fax:833-908-2287
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD446027OtherCOVENTRY
MD521116591OtherCIGNA
MD521116591OtherTRICARE
MD521116591OtherMARYLAND PHYSICIANS CARE
MD011373OtherPRIORITY PARTNERS
MD499726OtherNCPPO
MD8165984OtherOPTIMUM CHOICE MDIPA
MDP17422OtherCAREFIRST BC BS POS
MD54795104OtherCAREFIRST BC BS RENDERING
MD4008103OtherAETNA
MD784381000Medicaid
MD521116591OtherINFORMED
MDT5880039OtherCF BC BS GRP GHMSI BL CHO
MD521116591OtherMARYLAND PHYSICIANS CARE
MD521116591OtherINFORMED