Healthcare Provider Details

I. General information

NPI: 1487859328
Provider Name (Legal Business Name): DONNA MARIE HEPPER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7813 SHRADER RD
HENRICO VA
23294-4210
US

IV. Provider business mailing address

1447 YORK RD SUITE 301
LUTHERVILLE TIMONIUM MD
21093-6017
US

V. Phone/Fax

Practice location:
  • Phone: 804-264-4545
  • Fax:
Mailing address:
  • Phone: 410-252-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberD0073577
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberD0073577
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: