Provider Demographics
NPI:1245216555
Name:HETHERINGTON, RICHARD G (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:HETHERINGTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2757
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20195-0757
Mailing Address - Country:US
Mailing Address - Phone:703-471-0919
Mailing Address - Fax:703-742-9081
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:RESOTN HOSPITAL CENTER
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-471-0919
Practice Address - Fax:703-741-9081
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036876207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005707986Medicaid
173386OtherANTHEM
00A386R25Medicare ID - Type Unspecified