Provider Demographics
NPI:1831160233
Name:HENKIN, DAPHNA (MD)
Entity type:Individual
Prefix:
First Name:DAPHNA
Middle Name:
Last Name:HENKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DAPHNA
Other - Middle Name:
Other - Last Name:HENKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18121 GEORGIA AVE STE 103
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1437
Mailing Address - Country:US
Mailing Address - Phone:301-933-5050
Mailing Address - Fax:301-949-3262
Practice Address - Street 1:18121 GEORGIA AVE STE 103
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1437
Practice Address - Country:US
Practice Address - Phone:301-933-5050
Practice Address - Fax:301-949-3262
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00053528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD345900400Medicaid
408708Medicare PIN
MDG72971Medicare UPIN
MD345900400Medicaid