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Richard W Henthorn

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NPI Number Detailed Information

Provider Information:

Name: Richard W Henthorn
Gender: M
Provider License Number If Given: 35.043055

NPI Information:

NPI: 1750380259
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 11/10/2015

Provider Business Mailing Address:

Address: 3000 MACK RD STE 100
Fairfield, OH 45014
Phone Number: 5137514222
Fax Number: 5137514353

Provider Business Practice Location Address:

Address: 3000 MACK RD STE 100
Fairfield, OH 45014
Phone Number: 5137514222
Fax Number: 5137514353

Provider Taxonomy:

Primary: 207RC0000X
Secondary (if any): 207RC0001X
State: OH

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