Healthcare Provider Details

I. General information

NPI: 1063689867
Provider Name (Legal Business Name): HENRY DONALD KNOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 LORCOM CT
SPRINGFIELD VA
22152
US

IV. Provider business mailing address

6115 LORCOM CT
SPRINGFIELD VA
22152
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-6450
  • Fax: 703-451-6450
Mailing address:
  • Phone: 703-451-6450
  • Fax: 703-451-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101016596
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: