Healthcare Provider Details

I. General information

NPI: 1902856289
Provider Name (Legal Business Name): BRIAN DAVID HEYMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 THOMAS JOHNSON DR
FREDERICK MD
21702-4301
US

IV. Provider business mailing address

61 THOMAS JOHNSON DR
FREDERICK MD
21702-4301
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-6171
  • Fax: 301-695-4469
Mailing address:
  • Phone: 301-663-6171
  • Fax: 301-695-4469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberH0067140
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: