Healthcare Provider Details

I. General information

NPI: 1154635340
Provider Name (Legal Business Name): ANDREW DIXON HENEBRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 KINGSBOROUGH SQ STE 300
CHESAPEAKE VA
23320-4999
US

IV. Provider business mailing address

PO BOX 715868
PHILADELPHIA PA
19171-5868
US

V. Phone/Fax

Practice location:
  • Phone: 757-422-5476
  • Fax:
Mailing address:
  • Phone: 804-915-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number0101250177
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: