Provider Demographics
NPI:1720962806
Name:HENRY, WALTER III
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:HENRY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 GLENN DALE BLVD APT 1103
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9022
Mailing Address - Country:US
Mailing Address - Phone:202-436-2467
Mailing Address - Fax:
Practice Address - Street 1:11600 GLENN DALE BLVD APT 1103
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9022
Practice Address - Country:US
Practice Address - Phone:202-436-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant