Provider Demographics
NPI:1134146574
Name:HENRY, DAVID SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SIMON
Last Name:HENRY
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 1:49 CONNECTICUT BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3010
Mailing Address - Country:US
Mailing Address - Phone:860-282-0044
Mailing Address - Fax:860-282-0045
Practice Address - Street 1:1229 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-2132
Practice Address - Country:US
Practice Address - Phone:860-524-9820
Practice Address - Fax:860-524-9821
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036096207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001360966Medicaid
CT001360966Medicaid
CT060001393Medicare ID - Type Unspecified