Healthcare Provider Details

I. General information

NPI: 1942277439
Provider Name (Legal Business Name): ROBERT L HENDERSON M.D., F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10480 LITTLE PATUXENT PKWY SUITE 220
COLUMBIA MD
21044-3568
US

IV. Provider business mailing address

3680 HIPSLEY MILL RD
WOODBINE MD
21797-7612
US

V. Phone/Fax

Practice location:
  • Phone: 443-535-9451
  • Fax: 443-535-9455
Mailing address:
  • Phone: 301-854-6255
  • Fax: 410-489-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD0021351
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: