Provider Demographics
NPI:1578504460
Name:HENRY, VICTOR ELTON (DPM)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ELTON
Last Name:HENRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 JAYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-7206
Mailing Address - Country:US
Mailing Address - Phone:301-390-0959
Mailing Address - Fax:301-390-0959
Practice Address - Street 1:4000 ALBEMARLE ST NW
Practice Address - Street 2:SUITE 304
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-1851
Practice Address - Country:US
Practice Address - Phone:202-966-9300
Practice Address - Fax:301-390-0959
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCPO1000009213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC491281Medicare ID - Type Unspecified
DCT78572Medicare UPIN