Provider Demographics
NPI:1740993468
Name:HENRY, MEQUEDA C
Entity type:Individual
Prefix:
First Name:MEQUEDA
Middle Name:C
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 MAIN ST STE 422
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7174
Mailing Address - Country:US
Mailing Address - Phone:301-573-5524
Mailing Address - Fax:
Practice Address - Street 1:10560 MAIN ST STE 422
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7174
Practice Address - Country:US
Practice Address - Phone:703-624-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00000000Other000