Provider Demographics
NPI:1215566591
Name:HELLER, KEVIN N (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:N
Last Name:HELLER
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 1:9000 VIRGINIA MANOR RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-4214
Mailing Address - Country:US
Mailing Address - Phone:240-479-2719
Mailing Address - Fax:
Practice Address - Street 1:9000 VIRGINIA MANOR RD STE 200
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-4214
Practice Address - Country:US
Practice Address - Phone:240-479-2719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2202062080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology