Provider Demographics
NPI:1508876111
Name:HEYWOOD, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:HEYWOOD
Suffix:
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 1:3603 GROVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221
Mailing Address - Country:US
Mailing Address - Phone:804-358-2361
Mailing Address - Fax:804-359-0949
Practice Address - Street 1:3603 GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221
Practice Address - Country:US
Practice Address - Phone:804-358-2361
Practice Address - Fax:804-359-0949
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052104208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA113168OtherANTHEM
VA540597838OtherUNITED HEALTH CARE
VA38790OtherCARENET
VA006721567OtherVIRGINIA PREMIER
VA1006221OtherAETNA
VA287331OtherSOUTHERN HEALTH
VA3330964003OtherCIGNA
VA006721567Medicaid
VA45916OtherOPTIMA
VA45916OtherOPTIMA