Healthcare Provider Details

I. General information

NPI: 1720068588
Provider Name (Legal Business Name): CAROL L HENWOOD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 7TH ST STE 2A
PENNSBURG PA
18073-1512
US

IV. Provider business mailing address

649 N LEWIS RD SUITE 130
ROYERSFORD PA
19468-1234
US

V. Phone/Fax

Practice location:
  • Phone: 484-763-5445
  • Fax:
Mailing address:
  • Phone: 610-495-8101
  • Fax: 610-495-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS005316L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: