Healthcare Provider Details

I. General information

NPI: 1427364074
Provider Name (Legal Business Name): JOSEPH MAURICE HENRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MAPLE LN
GLEN MILLS PA
19342-2250
US

IV. Provider business mailing address

8 MAPLE LN
GLEN MILLS PA
19342-2250
US

V. Phone/Fax

Practice location:
  • Phone: 610-459-5471
  • Fax:
Mailing address:
  • Phone: 610-459-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC10002575
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD052023L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: