Provider Demographics
NPI:1912985250
Name:HEARST, KAREN A (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:HEARST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:804-504-7980
Mailing Address - Fax:804-554-5387
Practice Address - Street 1:524 SOUTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3609
Practice Address - Country:US
Practice Address - Phone:804-504-7980
Practice Address - Fax:804-554-5387
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101046978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F66945Medicare UPIN
VA016722C46Medicare PIN