1528249489 NPI number — DR. CHRISTOPHER PATRICK HENDERSON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528249489 NPI number — DR. CHRISTOPHER PATRICK HENDERSON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HENDERSON

Provider First Name:

CHRISTOPHER

Provider Middle Name:

PATRICK

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1528249489

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/20/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 783311

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PHILADELPHIA

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19178-3311

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

484-884-4500

Provider Business Mailing Address Fax Number:

484-884-0699

Provider First Line Business Practice Location Address:

334 MAIN ST

Provider Second Line Business Practice Location Address:

SUITE 1

Provider Business Practice Location Address City Name:

DICKSON CITY

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18519-1668

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

570-307-1767

Provider Business Practice Location Address Fax Number:

570-307-1770

Provider Enumeration Date:

11/20/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207X00000X , with the licence number:  MD439809 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207XS0117X , with the licence number: 42566 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207XS0117X , with the licence number: MD439809 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 3740628000 . This is a "PASSPORT ADVANTAGE- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 000000628566 . This is a "ANTHEM- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 107094 . This is a "SIHO- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 200951040 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 8850976 . This is a "CIGNA- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 7100084080 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 000051983Q . This is a "HUMANA- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 50025971 . This is a "PASSPORT- NORTON LEATHERMAN SPINE CENTER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".