Provider Demographics
NPI:1336122217
Name:HELLER, VIRGINIA R (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:R
Last Name:HELLER
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 1:3311 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2903
Mailing Address - Country:US
Mailing Address - Phone:918-742-2237
Mailing Address - Fax:918-742-7358
Practice Address - Street 1:3311 E 46TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2903
Practice Address - Country:US
Practice Address - Phone:918-742-2237
Practice Address - Fax:918-742-7358
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK189812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100112180BMedicaid
G01605Medicare UPIN