Provider Demographics
NPI:1154512556
Name:RACE, HEIDI N (PA-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:N
Last Name:RACE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 TIDEWATER COLONY DR
Mailing Address - Street 2:#1-A
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2101
Mailing Address - Country:US
Mailing Address - Phone:443-949-0814
Mailing Address - Fax:443-949-0825
Practice Address - Street 1:625 KENT AVE STE 302
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3775
Practice Address - Country:US
Practice Address - Phone:301-777-1930
Practice Address - Fax:301-777-8470
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003559363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical