Provider Demographics
NPI:1447357769
Name:MCHENRY, MICHAEL SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:MCHENRY
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 1:4881 STATE ROUTE 125
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-9550
Mailing Address - Country:US
Mailing Address - Phone:937-378-2526
Mailing Address - Fax:937-378-2540
Practice Address - Street 1:4881 STATE ROUTE 125
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-9550
Practice Address - Country:US
Practice Address - Phone:937-378-2526
Practice Address - Fax:937-378-2540
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00700232OtherMEDICARE RR
OH2015527Medicaid
OHP00700232OtherMEDICARE RR
OH0815307Medicare PIN