Provider Demographics
NPI:1417018607
Name:HERON, ALICIA GAIL (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:GAIL
Last Name:HERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:321 S PATRICK ST
Mailing Address - Street 2:HERON MEDICAL CENTER/SMART LIPO CENTER
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3534
Mailing Address - Country:US
Mailing Address - Phone:703-549-2626
Mailing Address - Fax:703-299-5080
Practice Address - Street 1:321 S PATRICK ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3534
Practice Address - Country:US
Practice Address - Phone:703-549-2626
Practice Address - Fax:703-299-5080
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101030856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine