Healthcare Provider Details

I. General information

NPI: 1508059429
Provider Name (Legal Business Name): PATRICIA W HENDERSON DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ARH LANE SUITE 800
LOW MOOR VA
24457
US

IV. Provider business mailing address

PO BOX 629
CLIFTON FORGE VA
24422-0629
US

V. Phone/Fax

Practice location:
  • Phone: 540-862-6750
  • Fax: 540-862-3742
Mailing address:
  • Phone: 540-862-6750
  • Fax: 540-862-3742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102037111
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110001381
License Number StateVA

VIII. Authorized Official

Name: DR. PATRICIA W HENDERSON
Title or Position: OWNER
Credential: D.O.
Phone: 540-862-6750