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NPI Code Detail

MEDICARE: MR. JOHN P HENRY CRNA

MEDICARE: MR. JOHN P HENRY CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology PhysicianRN-0001152041VA
2207L00000XAnesthesiology PhysicianCRNA-0024164722VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629077193
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN P HENRY CRNA
Provider Business Mailing Address
First Line : 3100 SPRING FOREST RD STE 130
Second Line :
City : RALEIGH
State : NC
Zip : 27616-2880
Country : US
Telephone Number : 888-280-9533
Fax Number : 919-873-9821
Provider Business Practice Location Address
First Line : 1001 SAM PERRY BLVD
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-4453
Country : US
Telephone Number : 540-741-7614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 03/17/2018

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