MEDICARE: DR. GEORGE DURHAM HENNING 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	207X00000X	Orthopaedic Surgery Physician	0101017408	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	1215914544	OTHER	VA	HUMANA MEDICARE
14	P00831108	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1215914544	OTHER	VA	SOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
2	1215914544	OTHER	VA	MAJESTACARE
3	1215914544	OTHER	VA	UNITED HEALTHCARE
4	1215914544	OTHER	VA	UMWA
5	1215914544	OTHER	VA	GATEWAY
7	1215914544	OTHER	VA	INTOTAL
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	1215914544	OTHER	VA	ANTHEM
10	371194700	OTHER	VA	BLACK LUNG
11	1215914544	OTHER	VA	CIGNA
12	1215914544	OTHER	VA	OPTIMA HEALTH PLAN
13	540506332115	OTHER	VA	TRICARE
15	1215914544	OTHER	VA	VIRGINIA PREMIER
16	1215914544	OTHER	VA	AETNA
17	1215914544	OTHER	VA	HEALTHKEEPERS
18	1215914544	OTHER	VA	HEALTHKEEPERS PLUS
19	1215914544	OTHER	VA	VIRGINIA HEALTH NETWORK

General Provider Information

NPI Number	:	1215914544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE DURHAM HENNING M.D.

Provider Business Mailing Address
First Line	:	4064 POSTAL DR
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-6438
Country	:	US
Telephone Number	:	540-725-1226
Fax Number	:	540-857-5306

Provider Business Practice Location Address
First Line	:	4064 POSTAL DR
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-6438
Country	:	US
Telephone Number	:	540-725-1226
Fax Number	:	540-857-5306

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	03/06/2014

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