Provider Demographics
NPI:1427016211
Name:HENRY, JOHN S (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
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 1:611 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750
Mailing Address - Country:US
Mailing Address - Phone:740-373-8756
Mailing Address - Fax:740-373-0091
Practice Address - Street 1:611 SECOND ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750
Practice Address - Country:US
Practice Address - Phone:740-373-8756
Practice Address - Fax:740-373-0091
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20112207X00000X
OH35077820207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV20112BOtherHEALTH PLAN BELPRE
000000117045OtherANTHEM
W77820OtherHEALTH PLAN MARIETTA
OH2179753Medicaid
232117571008OtherMEDICAL MUTUAL BELPRE
200039196OtherRR MEDICARE
000646012OtherBCBS
WV640016300Medicaid
W77820AOtherHLTH PLAN NEWMARTINSVILLE
WV640016300Medicaid
000000117045OtherANTHEM
OH2179753Medicaid