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1194784728

NPI Code Detail

MEDICARE: DR. MARK EDWARD HENNESSY M.D.

MEDICARE: DR. MARK EDWARD HENNESSY M.D.

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	207Q00000X	Family Medicine Physician	N4468	TX
2	207R00000X	Internal Medicine Physician	9500093	NC
3	207R00000X	Internal Medicine Physician	N4468	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8CQ712	OTHER	TX	BCBS
2	41696	OTHER	NC	BCBS PROVIDER NUMBER
3	11323149	OTHER	TX	UHC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194784728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK EDWARD HENNESSY M.D.

Provider Business Mailing Address
First Line	:	7515 MAIN ST STE 780
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4537
Country	:	US
Telephone Number	:	832-955-1221
Fax Number	:	832-968-3580

Provider Business Practice Location Address
First Line	:	14215 S POST OAK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-5233
Country	:	US
Telephone Number	:	832-541-8360
Fax Number	:

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	04/29/2024

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Directions to “ DR. MARK EDWARD HENNESSY M.D.” Practice Location

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