MEDICARE: ALICIA GAIL HERON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101030856	VA

General Provider Information

NPI Number	:	1417018607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA GAIL HERON M.D.

Provider Business Mailing Address
First Line	:	321 S PATRICK ST
Second Line	:	HERON MEDICAL CENTER/SMART LIPO CENTER
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-3534
Country	:	US
Telephone Number	:	703-549-2626
Fax Number	:	703-299-5080

Provider Business Practice Location Address
First Line	:	321 S PATRICK ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-3534
Country	:	US
Telephone Number	:	703-549-2626
Fax Number	:	703-299-5080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	06/19/2015

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