Provider Demographics
NPI:1922267749
Name:HENDERSON, VIRGINIA PATE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:PATE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 DEANS LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1531
Mailing Address - Country:US
Mailing Address - Phone:803-381-6517
Mailing Address - Fax:
Practice Address - Street 1:1021 PINNACLE POINT DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5740
Practice Address - Country:US
Practice Address - Phone:803-381-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC309242083P0901X
SCLL30924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine