MEDICARE: DR. ANDREW A. HENDERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	C10001921	DE
2	208D00000X	General Practice Physician	C10001921	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134210511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW A. HENDERSON MD

Provider Business Mailing Address
First Line	:	PO BOX 191
Second Line	:	PROVIDER ENROLLMENT DEPT
City	:	ROCKLAND
State	:	DE
Zip	:	19732-0191
Country	:	US
Telephone Number	:	302-651-6212
Fax Number	:	302-651-4945

Provider Business Practice Location Address
First Line	:	NEMOURS PEDIATRICS PHILADELPHIA PIKE
Second Line	:	222 PHILADELPHIA PIKE
City	:	WILMINGTON
State	:	DE
Zip	:	19809-3166
Country	:	US
Telephone Number	:	302-761-4660
Fax Number	:	302-761-4666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	09/21/2011

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