Healthcare Provider Details

I. General information

NPI: 1891182606
Provider Name (Legal Business Name): HEATHER MICHELLE BERNARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 ARLINGTON BLVD STE 200
FALLS CHURCH VA
22042-2336
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-531-3100
  • Fax: 703-531-3108
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number278549
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101273359
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: