Provider Demographics
NPI:1538269212
Name:HENDERSON, WENDY OWEN (MD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:OWEN
Last Name:HENDERSON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:508 FULTON ST
Mailing Address - Street 2:11C
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3875
Mailing Address - Country:US
Mailing Address - Phone:919-490-5239
Mailing Address - Fax:919-416-5835
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:11C
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:919-416-5835
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2012-10-04
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Provider Licenses
StateLicense IDTaxonomies
NC2001-01259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH82303Medicare UPIN