Healthcare Provider Details

I. General information

NPI: 1740205822
Provider Name (Legal Business Name): JOHN C HENRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MEDICAL CIR
WINCHESTER VA
22601-3322
US

IV. Provider business mailing address

125 MEDICAL CIR
WINCHESTER VA
22601-3322
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-1828
  • Fax: 540-722-3658
Mailing address:
  • Phone: 540-667-1828
  • Fax: 540-722-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number236665
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101251919
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: