Provider Demographics
NPI:1912067273
Name:HENDERSON, CHARLES GERRY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GERRY
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2724 FORT SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2305
Mailing Address - Country:US
Mailing Address - Phone:240-505-5402
Mailing Address - Fax:571-231-2611
Practice Address - Street 1:9300 DEWITT LOOP, ATTN: UROLOGY
Practice Address - Street 2:FORT BELVOIR COMMUNITY HOSPITAL
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:571-231-2633
Practice Address - Fax:571-231-2611
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL18271208800000X, 2088P0231X
CAG1883672088P0231X
FLME1319672088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021315000Medicaid