Israel V. Fernando

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036-101791 Issued in IL

Legal business name

ISRAEL V. FERNANDO

Doing business as

Advanced Dermatology

Practice address

1588 37TH Ave
Moline, IL 61265-7213

Phone

(309) 797-2713

Fax

(309) 797-9558

NPI assigned

Feb 23, 2011

Last updated

Feb 23, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Israel V. Fernando, M.D.NPI 1558473850

Title

Owner/Physician

Phone

(309) 797-2713

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Advanced Dermatology Doing business as

Tax ID family

Advanced Dermatology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Israel Fernando MD

  dba Advanced Dermatology

  • Dermatology Physician
  • Burlington, IA
  • NPI 1063461671
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Israel V Fernando, M.D.

  • Dermatology Physician
  • Moline, IL
  • NPI 1558473850
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298419200000",
    "number": "1366749616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1588 37TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657213",
            "telephone_number": "309-797-2713",
            "fax_number": "309-797-9558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1588 37TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657213",
            "telephone_number": "309-797-2713",
            "fax_number": "309-797-9558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISRAEL V. FERNANDO",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-23",
        "last_updated": "2011-02-23",
        "status": "A",
        "authorized_official_last_name": "FERNANDO",
        "authorized_official_first_name": "ISRAEL",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "309-797-2713",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036-101791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2252064",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brittney Michelle Ionescu, SLP
• Ioan Daniel Ionescu, PHARMD
• Iowa Physicians Clinic Medical Foundation (UnityPoint Clinic Workplace Health)
• Iowa Physicians Clinic Medical Foundation (Iowa Health Physicians)
• Rosendo Islas-Torres
• Itek Interpreting Solutions LLC
• Arled Izquierdo, MD
• J & S Kelly LLC (Kelly's Medical Equipment & Supply)
• J a K Enterprises Inc (Bard Optical)
• Harvey P Jack, D.C.

• Dermatology Physician in Moline, IL
• Providers in Moline, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.