MEDICARE: JAMES L HENDERSON MD

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	207L00000X	Anesthesiology Physician	D0024346	MD

General Provider Information

NPI Number	:	1750366860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES L HENDERSON MD

Provider Business Mailing Address
First Line	:	325 RESERVE GATE TER
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20905-5040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 RESERVE GATE TER
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20905-5040
Country	:	US
Telephone Number	:	240-417-9774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	07/08/2007

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