Provider Demographics
NPI:1598835902
Name:HENNING, JAMES SALWYN (MD, MHCDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SALWYN
Last Name:HENNING
Suffix:
Gender:M
Credentials:MD, MHCDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 POND ST
Mailing Address - Street 2:
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-1547
Mailing Address - Country:US
Mailing Address - Phone:650-269-5666
Mailing Address - Fax:774-521-3424
Practice Address - Street 1:113 POND ST
Practice Address - Street 2:
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-1547
Practice Address - Country:US
Practice Address - Phone:650-269-5666
Practice Address - Fax:774-521-3424
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25982207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0042170Medicaid
CAA24655Medicare UPIN
CA00A259820Medicare ID - Type UnspecifiedMEDICARE NO.