1497071310 NPI number — KATHLEEN RENEE HEIM M.D.

Table of content: KATHLEEN RENEE HEIM M.D. (NPI 1497071310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497071310 NPI number — KATHLEEN RENEE HEIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIM
Provider First Name:
KATHLEEN
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DORFLER
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497071310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1635 N GEORGE MASON DR STE 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22205-3633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-558-6077
Provider Business Mailing Address Fax Number:
703-558-6015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1635 N GEORGE MASON DR STE 190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22205-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-558-6077
Provider Business Practice Location Address Fax Number:
703-558-6015
Provider Enumeration Date:
04/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X , with the licence number:  0101262009 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1497071310 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1497071310 . This is a "CORVEL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1497071310 . This is a "USA MANAGED CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1497071310 . This is a "VIRGINIA PREMIER HEALTH PLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1497071310 . This is a "MULTIPLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1497071310 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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