Provider Demographics
NPI:1013982784
Name:HENRY, JOHN CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:HENRY
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 1:174 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4423
Mailing Address - Country:US
Mailing Address - Phone:301-228-2943
Mailing Address - Fax:301-228-2945
Practice Address - Street 1:174 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 204
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4423
Practice Address - Country:US
Practice Address - Phone:301-228-2943
Practice Address - Fax:301-228-2945
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039970174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD225281300Medicaid
MD225281300Medicaid