Provider Demographics
NPI:1801882352
Name:HENRY, LLOYD N (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:N
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00821-1126
Mailing Address - Country:US
Mailing Address - Phone:340-778-5450
Mailing Address - Fax:340-778-5450
Practice Address - Street 1:4500 SION FARM
Practice Address - Street 2:SUITE 1A, ISLAND MEDICAL CENTER
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4493
Practice Address - Country:US
Practice Address - Phone:340-778-5450
Practice Address - Fax:340-778-5450
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI183208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G42979Medicare UPIN
0024285Medicare ID - Type Unspecified