Provider Demographics
NPI:1255411872
Name:HENDRICKS, GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:HENDRICKS
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 1:104 KING FARM BLVD
Mailing Address - Street 2:APT. C303
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5862
Mailing Address - Country:US
Mailing Address - Phone:301-963-0963
Mailing Address - Fax:
Practice Address - Street 1:7475 WISCONSIN AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3412
Practice Address - Country:US
Practice Address - Phone:301-986-8010
Practice Address - Fax:301-986-8011
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046681207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0046681OtherMD LICENSE