Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | MD018597E | PA |
NPI | 1063406411 |
---|---|
Provider Name | David Holden Henry III |
First Address | Philadelphia, PA 19106-3500 |
Second Address | Philadelphia, PA 19106-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 09/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006622760001 | (05) | PA |
B96821 | (02) | PA |