Provider Demographics
NPI:1477558385
Name:HENEGAN, MARIKA L (MD)
Entity type:Individual
Prefix:DR
First Name:MARIKA
Middle Name:L
Last Name:HENEGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIKA
Other - Middle Name:L
Other - Last Name:OSTROSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:590 COURT ST
Mailing Address - Street 2:DARTMOUTH-HITCHCOCK KEENE
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1719
Mailing Address - Country:US
Mailing Address - Phone:603-354-5400
Mailing Address - Fax:603-354-6562
Practice Address - Street 1:590 COURT ST
Practice Address - Street 2:DARTMOUTH-HITCHCOCK KEENE
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1719
Practice Address - Country:US
Practice Address - Phone:603-354-5400
Practice Address - Fax:603-354-6562
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH01YP05493NH01OtherANTHEM
NH2139345OtherCIGNA
NH222594672OtherUNITED HEALTH CARE
NHAA3742OtherHARVARD PILGRIM
NH3422158OtherAETNA
NH373963OtherMVP HEALTHCARE
NH222594672OtherGREATWEST HEALTH CARE
NH222594672OtherPRIVATE HEALTH CARE
NH222594672OtherTRICARE
NH80300001Medicaid
NH222594672OtherHEALTHCARE VALUE MANAGE
NH80300001Medicaid
NH222594672OtherPRIVATE HEALTH CARE