Provider Demographics
NPI:1659302081
Name:HENRY, MARK RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-1300
Mailing Address - Fax:717-851-1310
Practice Address - Street 1:755 S PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-9252
Practice Address - Country:US
Practice Address - Phone:717-851-1300
Practice Address - Fax:717-851-1310
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053319L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1142348OtherAMERIHEALTH MERCY-WMG
PA80745OtherUNISON-WMG
PA001516352Medicaid
PA233496OtherMAMSI-WMG
MD542992OtherCAREFIRST MD BCBS
PA681097OtherHIGHMARK BLUE SHIELD
PA5898005OtherAETNA
PA1060701OtherCAPITAL BLUE CROSS-WMG
PA39761OtherGEISINGER
PA30032OtherJOHNS HOPKINS
PAP002800OtherGATEWAY-WMG
PA5898005OtherAETNA
PA30032OtherJOHNS HOPKINS
PA39761OtherGEISINGER