Provider Demographics
NPI:1568533099
Name:CAROLYN B. HENDRICKS, MD, PA
Entity Type:Organization
Organization Name:CAROLYN B. HENDRICKS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSEMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-897-1503
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 506
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-897-1503
Mailing Address - Fax:301-581-0254
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 506
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7822
Practice Address - Country:US
Practice Address - Phone:301-897-1503
Practice Address - Fax:301-581-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1212579OtherUNITED HEALTHCARE
MD4318989OtherAETNA PROVIDER NUMBER
MD670109OtherMAMSI
MD470CCBOtherCAREFIRST BCBS
MDN060 0001OtherBCBS NCA FEP
MD=========0012OtherCIGNA
MDG02264Medicare ID - Type Unspecified
MD=========0012OtherCIGNA