Healthcare Provider Details

I. General information

NPI: 1245492842
Provider Name (Legal Business Name): BRIAN DAVID HENRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 CORNELIA ST SUITE 102
PLATTSBURGH NY
12901-2317
US

IV. Provider business mailing address

214 CORNELIA ST SUITE 102
PLATTSBURGH NY
12901-2317
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-6410
  • Fax: 518-562-7542
Mailing address:
  • Phone: 518-561-6410
  • Fax: 518-562-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number280443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: