Provider Demographics
NPI:1942394127
Name:HENICK, JAMES HUGH (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HUGH
Last Name:HENICK
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 1:501 DISCOVERY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3843
Mailing Address - Country:US
Mailing Address - Phone:757-547-5145
Mailing Address - Fax:757-312-0216
Practice Address - Street 1:150 BURNETTS WAY STE 100
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8168
Practice Address - Country:US
Practice Address - Phone:757-547-5145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050548207L00000X
VA01010502572081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology