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General NPI Number Information
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NPI Number | 1508059429
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Entity Type | Organization
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Legal Business Name | PATRICIA W HENDERSON DO PC
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 1 ARH LANE SUITE 800
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City | LOW MOOR
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State | VA
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Zip | 24457
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Country | US
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Telephone | 540-862-6750
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Fax | 540-862-3742
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Provider Business Mailing Address
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Address Line | PO BOX 629
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City | CLIFTON FORGE
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State | VA
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Zip | 24422-0629
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Country | US
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Telephone | 540-862-6750
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Fax | 540-862-3742
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICIA W HENDERSON
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Credential | D.O.
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Telephone | 540-862-6750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110001381
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102037111
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License Number State | VA
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