Provider Demographics
NPI:1568633907
Name:HENRY D. MCKINNEY, M.D.
Entity Type:Organization
Organization Name:HENRY D. MCKINNEY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-944-7109
Mailing Address - Street 1:1800 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4508
Mailing Address - Country:US
Mailing Address - Phone:814-944-7109
Mailing Address - Fax:814-944-7950
Practice Address - Street 1:1800 GRANT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4508
Practice Address - Country:US
Practice Address - Phone:814-944-7109
Practice Address - Fax:814-944-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB35270Medicare UPIN