Provider Demographics
NPI:1194784728
Name:HENNESSY, MARK EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:HENNESSY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 MAIN ST STE 780
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4537
Mailing Address - Country:US
Mailing Address - Phone:832-955-1221
Mailing Address - Fax:832-968-3580
Practice Address - Street 1:14215 S POST OAK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-5233
Practice Address - Country:US
Practice Address - Phone:832-541-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4468207Q00000X, 207R00000X
NC9500093207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CQ712OtherBCBS
NC41696OtherBCBS PROVIDER NUMBER
TX11323149OtherUHC
NC8941696Medicaid
TX8CQ712OtherBCBS
NCG09932Medicare UPIN