Provider Demographics
NPI:1528249489
Name:HENDERSON, CHRISTOPHER PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:334 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1668
Practice Address - Country:US
Practice Address - Phone:570-307-1767
Practice Address - Fax:570-307-1770
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439809207X00000X, 207XS0117X
KY42566207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3740628000OtherPASSPORT ADVANTAGE- NORTON LEATHERMAN SPINE CENTER
KY000000628566OtherANTHEM- NORTON LEATHERMAN SPINE CENTER
KY107094OtherSIHO- NORTON LEATHERMAN SPINE CENTER
IN200951040Medicaid
KY8850976OtherCIGNA- NORTON LEATHERMAN SPINE CENTER
KY7100084080Medicaid
KY000051983QOtherHUMANA- NORTON LEATHERMAN SPINE CENTER
KY50025971OtherPASSPORT- NORTON LEATHERMAN SPINE CENTER
KY8850976OtherCIGNA- NORTON LEATHERMAN SPINE CENTER