Healthcare Provider Details

I. General information

NPI: 1619954351
Provider Name (Legal Business Name): JAMES ALLEN HENRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 BRAEBURN DR
SALEM VA
24153-7357
US

IV. Provider business mailing address

1802 BRAEBURN DR
SALEM VA
24153-7357
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-3547
  • Fax: 540-725-5053
Mailing address:
  • Phone: 540-772-3547
  • Fax: 540-725-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberM9400
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberMD00044905
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number0101055117
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: