Provider Demographics
NPI:1225003361
Name:HENRY, REGINALD B III (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:B
Last Name:HENRY
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:850 KEMPSVILLE RD
Mailing Address - Street 2:STE 100D
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502
Mailing Address - Country:US
Mailing Address - Phone:757-261-5944
Mailing Address - Fax:757-261-0026
Practice Address - Street 1:850 KEMPSVILLE RD
Practice Address - Street 2:STE 100D
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-261-5944
Practice Address - Fax:757-261-0026
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-11-17
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Provider Licenses
StateLicense IDTaxonomies
VA0101036226207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005900212Medicaid
VA005900212Medicaid
070000200Medicare ID - Type Unspecified