Provider Demographics
NPI:1972510246
Name:HENDERSON, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:HENDERSON
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 1:5400 FRANTZ RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10401 SAWMILL PKWY
Practice Address - Street 2:SUITE 20
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7451
Practice Address - Country:US
Practice Address - Phone:614-764-9955
Practice Address - Fax:614-792-5086
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-7551-H174400000X
OH35.037551208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH633764Medicaid
OH633764Medicaid
HE0615766Medicare PIN