Provider Demographics
NPI:1396006946
Name:HENRY, ZACHARY W (DO)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:W
Last Name:HENRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0763
Mailing Address - Country:US
Mailing Address - Phone:800-541-4009
Mailing Address - Fax:304-293-6963
Practice Address - Street 1:302 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:WV
Practice Address - Zip Code:26456-1108
Practice Address - Country:US
Practice Address - Phone:304-873-2590
Practice Address - Fax:304-873-1792
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV2751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program