Provider Demographics
NPI:1104802925
Name:MENSACK, HENRY N (PA-C)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:N
Last Name:MENSACK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-0607
Mailing Address - Country:US
Mailing Address - Phone:302-424-4141
Mailing Address - Fax:302-422-6506
Practice Address - Street 1:329 MULLET RUN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5373
Practice Address - Country:US
Practice Address - Phone:410-749-4154
Practice Address - Fax:410-860-9583
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184681488OtherCOMMERCIAL INSURANCES
DE1104802925Medicaid
51-0370286OtherUNION LABOR LIFE INSURANCE COMPANY
970008969OtherRAILROAD MEDICARE
DE1104802925Medicaid
510370286OtherEASTERN SUSSEX PHYSICIAN ORGANIZATION, P.A. (ESPO)
51-0370286OtherHEALTH NET - TRICARE/CHAMPUS
1104802925OtherBLUE CROSS BLUE SHIELD OF DELAWARE
51-0370286OtherDEVON HEALTH SERVICES
510370286OtherGREAT WEST HEALTHCARE
1104802925OtherBLUE CROSS BLUE SHIELD OF DELAWARE