Provider Demographics
NPI:1669470720
Name:CRAYTON, HEIDI (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:CRAYTON
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 1:8320 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3831
Mailing Address - Country:US
Mailing Address - Phone:703-226-4000
Mailing Address - Fax:703-226-4010
Practice Address - Street 1:8320 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3831
Practice Address - Country:US
Practice Address - Phone:703-226-4000
Practice Address - Fax:703-226-4010
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010563352084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02509T01Medicare PIN
G57328Medicare UPIN
VAG02530Medicare PIN