Provider Demographics
NPI:1902818701
Name:NEBLETT-ALEXANDER, HEATHER ANNE (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:NEBLETT-ALEXANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:NEBLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8821 COLUMBIA 100 PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2168
Mailing Address - Country:US
Mailing Address - Phone:410-997-6400
Mailing Address - Fax:410-730-6198
Practice Address - Street 1:8821 COLUMBIA 100 PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2168
Practice Address - Country:US
Practice Address - Phone:410-997-6400
Practice Address - Fax:410-730-6198
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00479942080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD943040700Medicaid
G16990Medicare UPIN
MD943040700Medicaid