Provider Demographics
NPI:1700856069
Name:TENNYSON, HEATH CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:CHARLES
Last Name:TENNYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 E PALMER RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2281
Mailing Address - Country:US
Mailing Address - Phone:937-592-9799
Mailing Address - Fax:937-592-9789
Practice Address - Street 1:1134 N MAIN ST STE 3100
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-0017
Practice Address - Country:US
Practice Address - Phone:937-592-9799
Practice Address - Fax:937-592-9789
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49866207Y00000X
IN1057676A207Y00000X
OH35.120409207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024975Medicaid
OH0078122Medicaid
AZ970673Medicaid