Provider Demographics
NPI:1205001898
Name:DREYFUSS, HEATH FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATH
Middle Name:FRANKLIN
Last Name:DREYFUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 N CLARK ST
Mailing Address - Street 2:APT 2302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5301
Mailing Address - Country:US
Mailing Address - Phone:248-563-5645
Mailing Address - Fax:
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:SUITE 303
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6007
Practice Address - Country:US
Practice Address - Phone:703-448-0005
Practice Address - Fax:730-448-0808
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253194207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101253194OtherMEDICAL LICENSE
VA278117ZDALMedicare PIN