Healthcare Provider Details

I. General information

NPI: 1194971622
Provider Name (Legal Business Name): DAVID HEYDT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11921 BOURNEFIELD WAY STE 100
SILVER SPRING MD
20904-7815
US

IV. Provider business mailing address

4617 PARK HEIGHTS AVE
BALTIMORE MD
21215-6331
US

V. Phone/Fax

Practice location:
  • Phone: 240-737-0080
  • Fax:
Mailing address:
  • Phone: 443-423-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0071698
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberD0071698
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: