Individual
DR. MICHAEL POTTER HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
825 FAIRFAX AVE, SUITE 710, NORFOLK, VA 23507-1914
(757) 446-5888
(757) 446-5918
Mailing address
PO BOX 936, NORFOLK, VA 23501-0936
(757) 446-5888
(757) 446-5918
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101242252
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427135086
OPTIMA BEHAVIORAL HEALTH
VA
05
—
1427135086
—
VA
01
—
413231
ANTHEM BC/BS
VA
05
—
5916090
—
NC
01
—
600484-052
MAGELLAN HEALTH SERVICES
VA
01
—
PAR
MANAGED HEALTH NETWORK/TRICARE
VA
Enumeration date
11/01/2006
Last updated
05/07/2014
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