Healthcare Provider Details

I. General information

NPI: 1245201789
Provider Name (Legal Business Name): MARILYN C HENDERSON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 MILLERSVILLE RD
LANCASTER PA
17603-6154
US

IV. Provider business mailing address

882 MILLERSVILLE ROAD
LANCASTER PA
17603
US

V. Phone/Fax

Practice location:
  • Phone: 717-291-0391
  • Fax: 717-291-0832
Mailing address:
  • Phone: 717-291-0391
  • Fax: 717-291-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC002642L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: