Provider Demographics
NPI:1487667523
Name:HENDERSON, RICK A (MD)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:A
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 HEALTHY WAY
Mailing Address - Street 2:SUITE 1120
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-7915
Mailing Address - Country:US
Mailing Address - Phone:864-512-4530
Mailing Address - Fax:864-512-4540
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:SUITE 1120
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7915
Practice Address - Country:US
Practice Address - Phone:864-512-4530
Practice Address - Fax:864-512-4540
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2005-00371207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913253Medicaid
SC376220Medicaid
NC5913253Medicaid
NC2073972Medicare PIN