Individual
DR. MADAHARI TYLER ALDHEM HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
905 THUNDER RD STE 140, ELIZABETH CITY, NC 27909-7672
(252) 334-0320
(855) 330-7320
Mailing address
1221 E STATE ST, ROCKFORD, IL 61104-2231
(815) 972-1000
(815) 972-1086
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
1790356251
NC
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/06/2021
Last updated
07/17/2024
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