Provider Demographics
NPI:1720174097
Name:HERON, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HERON
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 1:1145 - 19TH STREET, NW
Mailing Address - Street 2:SUITE 850
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-0328
Mailing Address - Country:US
Mailing Address - Phone:202-223-9040
Mailing Address - Fax:202-223-9047
Practice Address - Street 1:1145 - 19TH STREET, NW
Practice Address - Street 2:SUITE 850
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-0328
Practice Address - Country:US
Practice Address - Phone:202-223-9040
Practice Address - Fax:202-223-9047
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD10272207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5552-0001OtherCAREFIRST BCBS
DC00B893C40Medicare ID - Type Unspecified
DC5552-0001OtherCAREFIRST BCBS