Provider Demographics
NPI:1942277439
Name:HENDERSON, ROBERT L (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 HIPSLEY MILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-7612
Mailing Address - Country:US
Mailing Address - Phone:301-854-6255
Mailing Address - Fax:410-489-7773
Practice Address - Street 1:10480 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3568
Practice Address - Country:US
Practice Address - Phone:443-535-9451
Practice Address - Fax:443-535-9455
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021351207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0021351OtherMARYLAND LICENSE NUMBER
MD137031600Medicaid
MD137031602Medicaid
MD137031602Medicaid
MD137031600Medicaid
MDC61743Medicare UPIN
MD4282Medicare PIN