Healthcare Provider Details

I. General information

NPI: 1437159886
Provider Name (Legal Business Name): AMY HALLAL HENDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SILVERCREST DR SUITE 100
NEW ALBANY IN
47150-7800
US

IV. Provider business mailing address

2 SILVERCREST DR SUITE 100
NEW ALBANY IN
47150-7800
US

V. Phone/Fax

Practice location:
  • Phone: 812-948-1641
  • Fax: 812-941-0438
Mailing address:
  • Phone: 812-948-1641
  • Fax: 812-941-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01052944A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: