Healthcare Provider Details

I. General information

NPI: 1962467332
Provider Name (Legal Business Name): FREDERICK CHRISTAIN HEATON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 COMPUTER DR SUITE 201
RALEIGH NC
27609-6518
US

IV. Provider business mailing address

3809 COMPUTER DR SUITE 201
RALEIGH NC
27609-6518
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-6700
  • Fax: 919-782-2218
Mailing address:
  • Phone: 919-782-6700
  • Fax: 919-782-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number17988
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: