Active NPI
Lionel Gregory Fernando, MD
- Neurology Physician
- Wilmington, NC
National Provider Identifier
1013083146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 25796
- Practice address
- 5617 Maxwell PL
Wilmington, NC 28409-2966 - Phone
- (910) 742-9243
- Fax
- (888) 746-1787
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Psychiatry & Neurology) Physician | 2084A0401X | 25796 | NC | |
| Neurodevelopmental Disabilities Physician | 2084P0005X | 25796 | NC | |
| Neurology Physician | 2084N0400X | 25796 | NC | Primary |
Addresses
Primary practice location
5617 Maxwell PL
Wilmington, NC 28409-2966
Mailing address
PO Box 16310
Wilmington, NC 28408-6310
Phone (910) 742-9243
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8931711 | Medicaid | NC | |
| 31705 | Other | NC | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25796 | NC | MD | Neurodevelopmental Disabilities Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Hanover Community Health Center Incorporated | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Wilmington, NC
- NPI 1912954090
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402272000000",
"number": "1013083146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 16310",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284086310",
"telephone_number": "910-742-9243",
"fax_number": "888-746-1787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5617 MAXWELL PL",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284092966",
"telephone_number": "910-742-9243",
"fax_number": "888-746-1787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDO",
"first_name": "LIONEL",
"middle_name": "GREGORY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2014-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084A0401X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Medicine",
"state": "NC",
"license": "25796",
"primary": false
},
{
"code": "2084P0005X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurodevelopmental Disabilities",
"state": "NC",
"license": "25796",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NC",
"license": "25796",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8931711",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "31705",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.