Provider Demographics
NPI:1225263684
Name:HENRY, CHRISTOPHER ANSON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ANSON
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:287 MAIN ST
Mailing Address - Street 2:STE. 404
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7054
Mailing Address - Country:US
Mailing Address - Phone:207-795-2171
Mailing Address - Fax:207-795-8330
Practice Address - Street 1:287 MAIN ST
Practice Address - Street 2:STE. 404
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7054
Practice Address - Country:US
Practice Address - Phone:207-795-2171
Practice Address - Fax:207-795-8330
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2014-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEMD20247208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY NUMBER