Provider Demographics
NPI:1700998309
Name:HAVERT, CECILY DVORAK (MD)
Entity Type:Individual
Prefix:
First Name:CECILY
Middle Name:DVORAK
Last Name:HAVERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CECILY
Other - Middle Name:S
Other - Last Name:DVORAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3833 FAIRFAX DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1772
Mailing Address - Country:US
Mailing Address - Phone:703-525-8863
Mailing Address - Fax:703-525-2387
Practice Address - Street 1:3833 FAIRFAX DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1772
Practice Address - Country:US
Practice Address - Phone:703-525-8863
Practice Address - Fax:703-525-2387
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01011235692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC019790ZE8RMedicare PIN
VAI04879Medicare UPIN