Provider Demographics
NPI:1982619276
Name:HENRIKSEN, DANIEL SCOTT (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:SCOTT
Last Name:HENRIKSEN
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-7500
Mailing Address - Fax:717-848-2074
Practice Address - Street 1:1601 SOUTH QUEEN STREET
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403
Practice Address - Country:US
Practice Address - Phone:717-812-7500
Practice Address - Fax:717-848-2074
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047537L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50049087OtherBLUE CROSS
PA647453OtherBLUE SHIELD
PA001526967002Medicaid
G01090Medicare UPIN
PA356906FLTMedicare PIN
PA001526967002Medicaid
PAP01432491Medicare PIN