Healthcare Provider Details

I. General information

NPI: 1134293681
Provider Name (Legal Business Name): HENRY NG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DRIVE MHMC INTERNAL MEDICINE - PEDIATRICS
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

2500 METROHEALTH DR MHMC INTERNAL MEDICINE - PEDIATRICS
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-3680
  • Fax: 216-778-1384
Mailing address:
  • Phone: 216-778-3680
  • Fax: 216-778-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35086428
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number35086428
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: