Basic Information
| Provider Information | |||||||||
| NPI: | 1467666560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENRY | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CLEAVELAND | ||||||||
| OtherFirstName: | ERIN | ||||||||
| OtherMiddleName: | CATHERINE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9100 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232297722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8065359994 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5855 BREMO RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232261930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042877066 | ||||||||
| FaxNumber: | 8046739531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 05/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 0116018512 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 0101245311 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1467666560 | 05 | VA | MEDICAID |