Provider Demographics
NPI:1598104259
Name:HENDERSON, FRASER CUMMINS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRASER
Middle Name:CUMMINS
Last Name:HENDERSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 WAYNE AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5655
Mailing Address - Country:US
Mailing Address - Phone:301-557-9049
Mailing Address - Fax:
Practice Address - Street 1:1010 WAYNE AVE STE 420
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5655
Practice Address - Country:US
Practice Address - Phone:301-557-9049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0091659207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery