Provider Demographics
NPI:1255324539
Name:HENRY, SCOTT M (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:HENRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 GUILFORD DR #204
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5930
Mailing Address - Country:US
Mailing Address - Phone:301-694-8880
Mailing Address - Fax:301-663-0959
Practice Address - Street 1:7101 GUILFORD DR #204
Practice Address - Street 2:SUITE 204
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5930
Practice Address - Country:US
Practice Address - Phone:301-694-8880
Practice Address - Fax:301-663-0959
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01223213E00000X
PASC004183R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017481350001Medicaid
PA0015596180002Medicaid
MD410156100Medicaid
MD549685364Medicaid
PA1265459606Medicaid
PA817166UEEMedicare PIN
MD410156100Medicaid
MD065NMedicare PIN
MD549685364Medicaid
PA5362690002Medicare NSC
PA09251Medicare PIN
PA1017481350001Medicaid
MD941FMedicare PIN