Provider Demographics
NPI:1740221951
Name:HENDRICKS, OLAF G (MD)
Entity Type:Individual
Prefix:
First Name:OLAF
Middle Name:G
Last Name:HENDRICKS
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:PO BOX 4303
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00851-4303
Mailing Address - Country:US
Mailing Address - Phone:340-773-6523
Mailing Address - Fax:
Practice Address - Street 1:3A LITTLE FOUNTAIN
Practice Address - Street 2:
Practice Address - City:KINGSHILL
Practice Address - State:VI
Practice Address - Zip Code:00851-4303
Practice Address - Country:US
Practice Address - Phone:340-773-6523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI3262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry