Provider Demographics
NPI:1679749923
Name:HENDERSON, BRENDAN GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:GILBERT
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 STONER AVE
Mailing Address - Street 2:STE 305
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5698
Mailing Address - Country:US
Mailing Address - Phone:410-848-7117
Mailing Address - Fax:410-857-8575
Practice Address - Street 1:295 STONER AVE
Practice Address - Street 2:STE 305
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5698
Practice Address - Country:US
Practice Address - Phone:410-848-7117
Practice Address - Fax:410-857-8575
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD68966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program