Provider Demographics
NPI:1720068588
Name:HENWOOD, CAROL L (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:HENWOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 N LEWIS RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1234
Mailing Address - Country:US
Mailing Address - Phone:610-495-8101
Mailing Address - Fax:610-495-8106
Practice Address - Street 1:101 W 7TH ST STE 2A
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-1512
Practice Address - Country:US
Practice Address - Phone:484-763-5445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005316L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D98458Medicare UPIN
P00089209Medicare PIN
24156Medicare ID - Type Unspecified