Healthcare Provider Details

I. General information

NPI: 1760449466
Provider Name (Legal Business Name): JOHN HENLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 ALBERT SABIN WAY DEPARTMENT OF PATHOLOGY
CINCINNATI OH
45267-0001
US

IV. Provider business mailing address

231 ALBERT SABIN WAY DEPARTMENT OF PATHOLOGY
CINCINNATI OH
45267-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-4500
  • Fax: 513-558-2289
Mailing address:
  • Phone: 513-558-4500
  • Fax: 513-558-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number01048470
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: