Healthcare Provider Details

I. General information

NPI: 1871923805
Provider Name (Legal Business Name): DAVID HEPPEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7318 MEADOW WOOD WAY
CLARKSVILLE MD
21029-1711
US

IV. Provider business mailing address

7318 MEADOW WOOD WAY
CLARKSVILLE MD
21029-1711
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-2881
  • Fax:
Mailing address:
  • Phone: 301-498-2881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0024337
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: