Provider Demographics
NPI:1659364842
Name:HENRY, CHRISTINE ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ELLEN
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 1:891 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2118
Mailing Address - Country:US
Mailing Address - Phone:937-382-5030
Mailing Address - Fax:937-655-8390
Practice Address - Street 1:891 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2118
Practice Address - Country:US
Practice Address - Phone:937-382-5030
Practice Address - Fax:937-655-8390
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000020667OtherANTHEM
OH0420219OtherUNITED HEALTHCARE
OH0553306Medicaid
OH4620104OtherHUMANA CHOICECARE
OH000000020667OtherIRON WORKERS BENEFIT TRUS
OHIN9287051OtherMEDICARE GROUP
0014450OtherTRICARE FOR LIFE
OH0553306Medicaid
OH110061531Medicare PIN
0014450OtherTRICARE FOR LIFE
OHIN9287051OtherMEDICARE GROUP
OH000000020667OtherIRON WORKERS BENEFIT TRUS
OHHE0627232Medicare PIN
OH110147699Medicare PIN