Provider Demographics
NPI:1306052758
Name:NACE, HEATHER LYNNE (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNNE
Last Name:NACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNNE
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-706-1684
Mailing Address - Fax:410-706-4619
Practice Address - Street 1:725 W LOMBARD ST # N156
Practice Address - Street 2:INSTITUTE OF HUMAN VIROLOGY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1009
Practice Address - Country:US
Practice Address - Phone:410-706-1684
Practice Address - Fax:410-706-4619
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD71156207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD510437800Medicaid
MDP00877009Medicare PIN
MD188533Y2ZMedicare PIN