Provider Demographics
NPI:1821045626
Name:MCHENRY, ERIC M (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:MCHENRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1525 E STROOP RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5065
Mailing Address - Country:US
Mailing Address - Phone:937-208-7400
Mailing Address - Fax:937-208-7405
Practice Address - Street 1:1525 E STROOP RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5065
Practice Address - Country:US
Practice Address - Phone:937-208-7400
Practice Address - Fax:937-208-7405
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.059097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0778467Medicaid
E76057Medicare UPIN
OH0672373Medicare PIN
OH0672374Medicare PIN