Provider Demographics
NPI:1639131212
Name:HENRY, MECHEL M (MD)
Entity Type:Individual
Prefix:MS
First Name:MECHEL
Middle Name:M
Last Name:HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CLAY ST
Mailing Address - Street 2:STE 600
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1427
Mailing Address - Country:US
Mailing Address - Phone:510-222-5421
Mailing Address - Fax:510-222-5249
Practice Address - Street 1:1300 CLAY ST
Practice Address - Street 2:SUITE 600
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1425
Practice Address - Country:US
Practice Address - Phone:510-222-5421
Practice Address - Fax:510-222-5249
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76404208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A764040OtherMEDICARE RELATED
146554Medicare UPIN