MEDICARE: JOSE HENAO 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	207P00000X	Emergency Medicine Physician	0101231089	VA

General Provider Information

NPI Number	:	1922075340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE HENAO MD

Provider Business Mailing Address
First Line	:	620 JOHN PAUL JONES CIR
Second Line	:	EMERGENCY MEDICINE DEPARTMENT
City	:	PORTSMOUTH
State	:	VA
Zip	:	23708-2111
Country	:	US
Telephone Number	:	757-953-1365
Fax Number	:

Provider Business Practice Location Address
First Line	:	472 POLARIS AVE
Second Line	:	BLDG 586
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23461-2111
Country	:	US
Telephone Number	:	757-862-2729
Fax Number	:

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	03/18/2021

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