Provider Demographics
NPI:1811970338
Name:HENWOOD, WILLIAM R (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:HENWOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 E MARKET ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6637
Mailing Address - Country:US
Mailing Address - Phone:330-841-9590
Mailing Address - Fax:330-841-1122
Practice Address - Street 1:1353 E MARKET ST
Practice Address - Street 2:SUITE 302
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6637
Practice Address - Country:US
Practice Address - Phone:330-841-9590
Practice Address - Fax:330-841-1122
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003720L208600000X
OH34-004295208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000795719Medicaid
PA101094RN0Medicare PIN
PA000795719Medicaid