Basic Information
| Provider Information | |||||||||
| NPI: | 1396006946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENRY | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 763 | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265070763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005414009 | ||||||||
| FaxNumber: | 3042936963 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | WEST UNION | ||||||||
| State: | WV | ||||||||
| PostalCode: | 264561108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048732590 | ||||||||
| FaxNumber: | 3048731792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2012 | ||||||||
| LastUpdateDate: | 04/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 2751 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.