Provider Demographics
NPI:1023078821
Name:BURNETT, HENRY WARREN (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:WARREN
Last Name:BURNETT
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 1:110 OAKWOOD DR STE 380
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1958
Mailing Address - Country:US
Mailing Address - Phone:336-765-3930
Mailing Address - Fax:336-765-3483
Practice Address - Street 1:110 OAKWOOD DR STE 380
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1958
Practice Address - Country:US
Practice Address - Phone:336-765-3930
Practice Address - Fax:336-765-3483
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600016207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920027Medicaid
F24141Medicare UPIN
2219093AMedicare ID - Type Unspecified