Active NPI
Kenneth George Henry, PH.D.
- Audiologist
- Frederick, MD
National Provider Identifier
1689754012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 01467
- Practice address
- 163 Thomas Johnson Dr Ste H
Frederick, MD 21702-4673 - Phone
- (301) 694-9111
- Fax
- (301) 739-0402
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 2201000526 | VA | |
| Audiologist | 231H00000X | 01467 | MD | Primary |
Addresses
Primary practice location
163 Thomas Johnson Dr Ste H
Frederick, MD 21702-4673
Mailing address
1800 Dual Hwy Ste 303
Hagerstown, MD 21740-6648
Phone (301) 739-0400
Other practice location 1
1800 Dual Hwy Ste 303
Hagerstown, MD 21740-6648
Phone (301) 739-0400
Other practice location 2
6231 Leesburg Pike
Suite 512
Falls Church, VA 22044-2102
Phone (703) 536-1666
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009451412 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01467 | MD | MD | Audiologist |
| 2201000526 | VA | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547769600000",
"number": "1689754012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 DUAL HWY STE 303",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "217406648",
"telephone_number": "301-739-0400",
"fax_number": "301-739-0402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "163 THOMAS JOHNSON DR STE H",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217024673",
"telephone_number": "301-694-9111",
"fax_number": "301-739-0402"
}
],
"practiceLocations": [
{
"address_1": "1800 Dual Hwy Ste 303",
"address_purpose": "LOCATION",
"city": "Hagerstown",
"state": "MD",
"postal_code": "217406648",
"country_code": "US",
"telephone_number": "301-739-0400",
"fax_number": "301-739-0402",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6231 Leesburg Pike",
"address_2": "Suite 512",
"address_purpose": "LOCATION",
"city": "Falls Church",
"state": "VA",
"postal_code": "220442102",
"country_code": "US",
"telephone_number": "703-536-1666",
"fax_number": "703-536-5337",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HENRY",
"first_name": "KENNETH",
"middle_name": "GEORGE",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2019-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "VA",
"license": "2201000526",
"primary": false
},
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "MD",
"license": "01467",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009451412",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Frederick, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.