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1477558385

NPI Code Detail

MEDICARE: DR. MARIKA L HENEGAN MD

MEDICARE: DR. MARIKA L HENEGAN 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	207Q00000X	Family Medicine Physician	12113	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01YP05493NH01	OTHER	NH	ANTHEM
2	2139345	OTHER	NH	CIGNA
3	222594672	OTHER	NH	UNITED HEALTH CARE
4	AA3742	OTHER	NH	HARVARD PILGRIM
5	3422158	OTHER	NH	AETNA
6	373963	OTHER	NH	MVP HEALTHCARE
7	222594672	OTHER	NH	GREATWEST HEALTH CARE
8	222594672	OTHER	NH	PRIVATE HEALTH CARE
9	222594672	OTHER	NH	TRICARE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	222594672	OTHER	NH	HEALTHCARE VALUE MANAGE

General Provider Information

NPI Number	:	1477558385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIKA L HENEGAN MD

Provider Business Mailing Address
First Line	:	590 COURT ST
Second Line	:	DARTMOUTH-HITCHCOCK KEENE
City	:	KEENE
State	:	NH
Zip	:	03431-1719
Country	:	US
Telephone Number	:	603-354-5400
Fax Number	:	603-354-6562

Provider Business Practice Location Address
First Line	:	590 COURT ST
Second Line	:	DARTMOUTH-HITCHCOCK KEENE
City	:	KEENE
State	:	NH
Zip	:	03431-1719
Country	:	US
Telephone Number	:	603-354-5400
Fax Number	:	603-354-6562

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/22/2017

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Directions to “ DR. MARIKA L HENEGAN MD” Practice Location

Language	Start Address	Practice Location

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