Basic Information
| Provider Information | |||||||||
| NPI: | 1053353805 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WYNN | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | SINAI CARDIOVASCULAR FACULTY GROUP PRACTICE | ||||||||
| Address2: | 5051 GREENSPRING AVE. SUITE 304 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1060177904 | ||||||||
| FaxNumber: | 4106018704 | ||||||||
| Practice Location | |||||||||
| Address1: | SINAI CARDIOVASCULAR FACULTY GROUP PRACTICE | ||||||||
| Address2: | 5051 GREENSPRING AVE. SUITE 304 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1060177904 | ||||||||
| FaxNumber: | 4106018704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 05/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | C00420 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.