Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 17118 | NC |
NPI | 1093776619 |
---|---|
Provider Name | Dr. Mark Henry Hennington |
First Address | Hickory, NC 28601-5046 |
Second Address | Hickory, NC 28601-5046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 23/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3760384 | CAROLINA CARE PLAN (PHP) (01) | NC |
8941658 | (05) | NC |
F95165 | (02) |