Provider Demographics
NPI:1710241658
Name:VANPALA, HENRY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JOSEPH
Last Name:VANPALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:JOSEPH
Other - Last Name:VANPALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2500 DUNHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-5104
Mailing Address - Country:US
Mailing Address - Phone:919-795-1399
Mailing Address - Fax:919-821-5170
Practice Address - Street 1:4822 SIX FORKS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5269
Practice Address - Country:US
Practice Address - Phone:919-795-1399
Practice Address - Fax:919-821-5170
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005421207RG0100X
SC35424207RG0100X
NC28586207RG0100X
VA010125463207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology