Provider Demographics
NPI:1659374171
Name:HENDERSON, THOMAS H (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:STE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8996
Mailing Address - Fax:937-396-0045
Practice Address - Street 1:4120 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1547
Practice Address - Country:US
Practice Address - Phone:937-848-6421
Practice Address - Fax:937-848-6391
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34001579H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000227904OtherANTHEM
OH000000227904OtherUNICARE
OH08019714OtherRAILROAD MEDICARE
OH34001579HOtherMEDICAL LICENSE
OHDO157904OtherHUMANA/CHOICECARE
OHOC02946OtherNATIONWIDE HEALTH PLAN
OH0120071OtherUNITED HEALTHCARE
OH2220247OtherAETNA
OH0054006Medicaid
OH421534506082OtherCARESOURCE
OH2220247OtherAETNA
OHHE0014664Medicare PIN