Provider Demographics
NPI:1003817164
Name:HEATON, JR, ROBERT B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:HEATON, JR
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:9901 MEDICAL CENTER DR
Mailing Address - Street 2:ADVENTIST PATHOLOGY ASSOCIATES
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3357
Mailing Address - Country:US
Mailing Address - Phone:301-279-6094
Mailing Address - Fax:301-217-5209
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:ADVENTIST PATHOLOGY ASSOCIATES
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3357
Practice Address - Country:US
Practice Address - Phone:301-279-6094
Practice Address - Fax:301-217-5209
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2016-12-08
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Provider Licenses
StateLicense IDTaxonomies
MDD0056337207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI42345Medicare UPIN