Basic Information
| Provider Information | |||||||||
| NPI: | 1457388118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENRY | ||||||||
| FirstName: | BRIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8309 BON AIR STATION CT | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232353172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043307971 | ||||||||
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| Practice Location | |||||||||
| Address1: | 727 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EMPORIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238471274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343484500 | ||||||||
| FaxNumber: | 4343484506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 01/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101042757 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10351499 | 05 | VA | MEDICAID | P00368549 | 01 | RAILROAD MCR | OTHER |