Healthcare Provider Details

I. General information

NPI: 1598835902
Provider Name (Legal Business Name): JAMES SALWYN HENNING M.D., MHCDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 POND ST
OSTERVILLE MA
02655-1547
US

IV. Provider business mailing address

113 POND ST
OSTERVILLE MA
02655-1547
US

V. Phone/Fax

Practice location:
  • Phone: 650-269-5666
  • Fax: 774-521-3424
Mailing address:
  • Phone: 650-269-5666
  • Fax: 774-521-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA25982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: