Healthcare Provider Details

I. General information

NPI: 1477609345
Provider Name (Legal Business Name): PATRICK MICHAEL HENDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL AMERICANO, BASE NAVAL DE ROTA APARTADO DE CORREOS 33
ROTA CADIZ
11530
ES

IV. Provider business mailing address

1 WAHOO AVE
GROTON CT
06349-2324
US

V. Phone/Fax

Practice location:
  • Phone: 346-414-8117
  • Fax:
Mailing address:
  • Phone: 860-694-7555
  • Fax: 860-694-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01064125A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: