Provider Demographics
NPI:1194794677
Name:HENRY, MARK F (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:HENRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:430 BATH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2637
Mailing Address - Country:US
Mailing Address - Phone:207-442-0350
Mailing Address - Fax:207-442-0355
Practice Address - Street 1:430 BATH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2637
Practice Address - Country:US
Practice Address - Phone:207-442-0350
Practice Address - Fax:207-442-0355
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2015-01-23
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Provider Licenses
StateLicense IDTaxonomies
ME011476207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME270740099Medicaid
ME015510Medicare PIN
MED03688Medicare UPIN
ME1006390001Medicare NSC