Provider Demographics
NPI:1275598716
Name:SAMPANG, HEIDI L (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:SAMPANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 5TH ST S
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1681
Mailing Address - Country:US
Mailing Address - Phone:703-979-6737
Mailing Address - Fax:
Practice Address - Street 1:5502 BACKLICK RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3904
Practice Address - Country:US
Practice Address - Phone:703-642-8306
Practice Address - Fax:703-891-4495
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238258208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics