Provider Demographics
NPI:1972587251
Name:HENRY, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:120 TRADEPARK DR
Mailing Address - Street 2:STE A
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3454
Mailing Address - Country:US
Mailing Address - Phone:606-679-7778
Mailing Address - Fax:606-451-1814
Practice Address - Street 1:120 TRADEPARK DR
Practice Address - Street 2:STE A
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3454
Practice Address - Country:US
Practice Address - Phone:606-679-7778
Practice Address - Fax:606-451-1814
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2013-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY27260207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000071743OtherBCBS
TN4020794Medicaid
1520956OtherUMWA
KY64272602Medicaid
180028760OtherRAILROAD MEDICARE
TN3061400OtherBLUE CROSS
E67778Medicare UPIN
KY64272602Medicaid