Provider Demographics
NPI:1528200904
Name:HENDERSON, JOSEPH WELLES IV (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WELLES
Last Name:HENDERSON
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27100 CHARDON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1192
Mailing Address - Country:US
Mailing Address - Phone:440-516-8700
Mailing Address - Fax:216-201-5276
Practice Address - Street 1:27100 CHARDON ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:440-516-8700
Practice Address - Fax:216-201-5276
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35124412207V00000X
OH35-124412207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology