Healthcare Provider Details

I. General information

NPI: 1972676575
Provider Name (Legal Business Name): HEATHER M. STEC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/27/2023
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12330 PINECREST RD SUITE 250
RESTON VA
20191-1642
US

IV. Provider business mailing address

12011 LEE JACKSON MEMORIAL HWY SUITE 504
FAIRFAX VA
22033-3310
US

V. Phone/Fax

Practice location:
  • Phone: 703-476-1050
  • Fax: 703-476-7126
Mailing address:
  • Phone: 703-391-2030
  • Fax: 703-273-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101233488
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: