Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 20803 | DC |
NPI | 1063404788 |
---|---|
Provider Name | Fraser Henderson |
First Address | Chevy Chase, MD 20815-5829 |
Second Address | Chevy Chase, MD 20814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 02/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D17649 | (02) |