Provider Demographics
NPI:1902875206
Name:HENTHORN, NORMAN (PA-C)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:HENTHORN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 CULTIVATION LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-4331
Mailing Address - Country:US
Mailing Address - Phone:207-975-1658
Mailing Address - Fax:
Practice Address - Street 1:107 W HARGETT ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1700
Practice Address - Country:US
Practice Address - Phone:919-550-0821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES40499Medicare UPIN
MEAP2461Medicare ID - Type Unspecified