Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | D0053308 | MD |
N | 208600000X | Surgeon | D0053308 | MD |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | D0053308 | MD |
NPI | 1033179098 |
---|---|
Provider Name | Dr. Gavin L Henry |
First Address | Baltimore, MD 21264-4226 |
Second Address | Baltimore, MD 21201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 13/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
407680000 | (05) | MD |
H02490 | (02) | |
K51964580202 | CAREFIRST (01) | MD |
W6620199 | CAREFIRST (01) | DC |