Fred M Henretig, M.D.

Primary specialty

Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X

License

MD017526E Issued in PA

Practice address

3401 Civic Center Blvd
Children'S Hospital of Phila - Medical Toxicology
Philadelphia, PA 19104-4319

Phone

(215) 590-1944

Fax

(215) 590-4454

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Childrens Health Care Associates, Inc

  • Pediatrics Physician
  • Philadelphia, PA
  • NPI 1598869059
  Medicare reassignment NPD
• Childen'S Health Care Associates Inc.

  • Pediatric Registered Nurse
  • Philadelphia, PA
  • NPI 1699860643
  NPD
• Childrens Health Care Associates, Inc

  • Developmental - Behavioral Pediatrics Physician
  • Philadelphia, PA
  • NPI 1548355597
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366329600000",
    "number": "1053334862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E PENN SQ",
            "address_2": "9TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073323",
            "telephone_number": "267-425-9234",
            "fax_number": "267-425-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "CHILDREN'S HOSPITAL OF PHILA - MEDICAL TOXICOLOGY",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-1944",
            "fax_number": "215-590-4454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRETIG",
        "first_name": "FRED",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2013-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD017526E",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "PA",
            "license": "MD017526E",
            "primary": true
        },
        {
            "code": "2080T0002X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Medical Toxicology",
            "state": "PA",
            "license": "MD017526E",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3618501",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000764267",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Hennessy, PHARMD
• Laura Hennessy, MS, LCGC
• Stephen P Hennessy, DC
• Joanne Henning, CRNP
• Jessica Henninger, PSYD,
• Rebecca Henrich
• Kevin D Henrichsen, MD
• Sarah Emily Henrickson, M.D. PH.D.
• Paulina Henriquez Rojas, MD
• Henry Ave Phcy

• Pediatric Emergency Medicine (Pediatrics) Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Pediatric Emergency Medicine (Pediatrics) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.