Mark A Henley, MD | |
601 Childrens Ln, Norfolk, VA 23507-1910 | |
(757) 668-7456 | |
(757) 668-9255 |
Full Name | Mark A Henley |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 601 Childrens Ln, Norfolk, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1467406561 | NPI | - | NPPES |
745611500 | Medicaid | MD | |
006722610 | Medicaid | VA | |
7905636 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 0101045119 (Virginia) | Primary |
2080N0001X | Pediatrics - Neonatal-perinatal Medicine | 0101045119 (Virginia) | Secondary |
Entity Name | Childrens Specialty Group Pllc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1255354130 PECOS PAC ID: 5890788764 Enrollment ID: O20040406001195 |
Mailing Address | Practice Location Address |
---|---|
Mark A Henley, MD Po Box 79137, Baltimore, MD 21279-0137 Ph: (757) 668-7200 | Mark A Henley, MD 601 Childrens Ln, Norfolk, VA 23507-1910 Ph: (757) 668-7456 |
Joshua Wayne Gollub, Pediatrics Medicare: Medicare Enrolled Practice Location: 601 Childrens Ln, Norfolk, VA 23507 Phone: 757-668-7000 | |
Stephen C. Restaino, DO Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 601 Childrens Ln, Norfolk, VA 23507 Phone: 757-668-7179 Fax: 757-668-9810 | |
Michael Lee Smith, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 601 Childrens Ln, Norfolk, VA 23507 Phone: 757-668-7456 Fax: 757-668-9255 | |
Phyllis R. Hope, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 601 Childrens Ln, Norfolk, VA 23507 Phone: 757-668-7456 Fax: 757-668-9255 | |
Linda D Pegram, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 601 Childrens Ln, Norfolk, VA 23507 Phone: 757-668-7007 Fax: 757-668-8658 | |
Ernette Yvonne Benson-foulk, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 6345 Center Dr, Building 14, Norfolk, VA 23502 Phone: 757-461-4027 Fax: 757-461-8821 | |
Dr. Phuongkhanh Huy Cromwell, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 601 Childrens Ln, Norfolk, VA 23507 Phone: 804-695-0305 |