Provider Demographics
NPI:1215914544
Name:HENNING, GEORGE DURHAM (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DURHAM
Last Name:HENNING
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 1:4064 POSTAL DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6438
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:4064 POSTAL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6438
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101017408207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215914544OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1215914544OtherMAJESTACARE
VA1215914544OtherUNITED HEALTHCARE
VA1215914544OtherUMWA
VA1215914544OtherGATEWAY
VA1215914544OtherHUMANA MEDICARE
VA1215914544OtherINTOTAL
VA1215914544Medicaid
VA1215914544OtherANTHEM
VA371194700OtherBLACK LUNG
VA1215914544OtherCIGNA
VA1215914544OtherOPTIMA HEALTH PLAN
VA540506332115OtherTRICARE
VAP00831108OtherRAILROAD MEDICARE
VA1215914544OtherVIRGINIA PREMIER
VA1215914544OtherAETNA
VA1215914544OtherHEALTHKEEPERS
VA1215914544OtherHEALTHKEEPERS PLUS
VA1215914544OtherVIRGINIA HEALTH NETWORK
VA023149C19Medicare PIN