Provider Demographics
NPI:1093776619
Name:HENNINGTON, MARK HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HENRY
Last Name:HENNINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5046
Mailing Address - Country:US
Mailing Address - Phone:828-323-1100
Mailing Address - Fax:828-324-9189
Practice Address - Street 1:420 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5046
Practice Address - Country:US
Practice Address - Phone:828-323-1100
Practice Address - Fax:828-324-9189
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17118208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8941658Medicaid
NC3760384OtherCAROLINA CARE PLAN (PHP)
2206572Medicare ID - Type Unspecified
NC8941658Medicaid