MEDICARE: MARSHALL MCHENRY,M.D., LLC

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
1	207R00000X	Internal Medicine Physician	35046952	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DD9897	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000195243	OTHER	OH	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639259724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL MCHENRY,M.D., LLC

Provider Business Mailing Address
First Line	:	4871 PROSPERITY PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-4027
Country	:	US
Telephone Number	:	513-251-9900
Fax Number	:	513-244-3999

Provider Business Practice Location Address
First Line	:	4871 PROSPERITY PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-4027
Country	:	US
Telephone Number	:	513-251-9900
Fax Number	:	513-244-3999

Authorized Official
Title or Position	:	OWNER
Name	:	MARSHALL MCHENRY
Credential	:	M.D.
Telephone Number	:	513-251-9900

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	01/18/2008

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Directions to “MARSHALL MCHENRY,M.D., LLC ” Practice Location

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