Provider Demographics
NPI:1932196128
Name:TY, HENRY Y (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:Y
Last Name:TY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1754
Mailing Address - Country:US
Mailing Address - Phone:978-687-2321
Mailing Address - Fax:978-685-7265
Practice Address - Street 1:354 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1754
Practice Address - Country:US
Practice Address - Phone:978-687-2321
Practice Address - Fax:978-685-7265
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12042207T00000X
MA218030207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA59840OtherFCHP
MAJ26789OtherBCBS
MA2020670Medicaid
MA7456469OtherAETNA
MA7960842-001OtherCIGNA
MAAA1709OtherHPHC
NH01Y007853MA01OtherANTHEM
MA05-00833OtherEVERCARE
MA05-00938OtherUHC
MA467235OtherTHP
MA0030531OtherNHP
NH30203970Medicaid
MA05-00833OtherEVERCARE
MA59840OtherFCHP
NH30203970Medicaid