Healthcare Provider Details

I. General information

NPI: 1881759124
Provider Name (Legal Business Name): CYNTHIA L HEINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14139 POTOMAC MILLS ROAD
WOODBRIDGE VA
22192-4644
US

IV. Provider business mailing address

1501 SAN PEDRO SEDR
ALBUQUERQUE NM
87108-5153
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-8400
  • Fax: 703-490-7635
Mailing address:
  • Phone: 505-265-1711
  • Fax: 505-255-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number031439
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: