Provider Demographics
NPI:1497071310
Name:HEIM, KATHLEEN RENEE (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RENEE
Last Name:HEIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:RENEE
Other - Last Name:DORFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1635 N GEORGE MASON DR STE 190
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3633
Mailing Address - Country:US
Mailing Address - Phone:703-558-6077
Mailing Address - Fax:703-558-6015
Practice Address - Street 1:1635 N GEORGE MASON DR STE 190
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3633
Practice Address - Country:US
Practice Address - Phone:703-558-6077
Practice Address - Fax:703-558-6015
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101262009207VM0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497071310Medicaid
1497071310OtherCORVEL
VA1497071310OtherUSA MANAGED CARE
VA1497071310OtherVIRGINIA PREMIER HEALTH PLAN
VA1497071310OtherMULTIPLAN
VA1497071310OtherTRICARE/CHAMPUS