MEDICARE: DR. VICTOR ELTON HENRY DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	PO1000009	DC

General Provider Information

NPI Number	:	1578504460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR ELTON HENRY DPM

Provider Business Mailing Address
First Line	:	400 JAYSTONE CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-7206
Country	:	US
Telephone Number	:	301-390-0959
Fax Number	:	301-390-0959

Provider Business Practice Location Address
First Line	:	4000 ALBEMARLE ST NW
Second Line	:	SUITE 304
City	:	WASHINGTON
State	:	DC
Zip	:	20016-1851
Country	:	US
Telephone Number	:	202-966-9300
Fax Number	:	301-390-0959

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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