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General NPI Number Information
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NPI Number | 1154512556
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Entity Type | Individual
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Provider Name | HEIDI N RACE PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 625 KENT AVE STE 302
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City | CUMBERLAND
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State | MD
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Zip | 21502-3775
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Country | US
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Telephone | 301-777-1930
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Fax | 301-777-8470
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Provider Business Mailing Address
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Address Line | 2007 TIDEWATER COLONY DR #1-A
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City | ANNAPOLIS
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State | MD
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Zip | 21401-2101
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Country | US
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Telephone | 443-949-0814
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Fax | 443-949-0825
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0003559
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License Number State | MD
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