Provider Demographics
NPI:1952465395
Name:HERON, A R JR (MD)
Entity Type:Individual
Prefix:
First Name:A
Middle Name:R
Last Name:HERON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S PATRICK ST
Mailing Address - Street 2:
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:703-836-1043
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:703-836-1043
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00031092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA069482OtherBCBS VA
VAD08560Medicare UPIN
VA192184Medicare ID - Type Unspecified