MEDICARE: KENNETH GEORGE HENRY PH.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	231H00000X	Audiologist	2201000526	VA
2	231H00000X	Audiologist	01467	MD

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

General Provider Information

NPI Number	:	1689754012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH GEORGE HENRY PH.D.

Provider Business Mailing Address
First Line	:	1800 DUAL HWY STE 303
Second Line	:
City	:	HAGERSTOWN
State	:	MD
Zip	:	21740-6648
Country	:	US
Telephone Number	:	301-739-0400
Fax Number	:	301-739-0402

Provider Business Practice Location Address
First Line	:	163 THOMAS JOHNSON DR STE H
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4673
Country	:	US
Telephone Number	:	301-694-9111
Fax Number	:	301-739-0402

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/18/2019

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