Provider Demographics
NPI:1538194626
Name:HEATON, RONALD C (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:HEATON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1315
Mailing Address - Country:US
Mailing Address - Phone:410-426-6370
Mailing Address - Fax:410-426-3491
Practice Address - Street 1:6310 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1315
Practice Address - Country:US
Practice Address - Phone:410-426-6370
Practice Address - Fax:410-426-3491
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
G274Medicare ID - Type Unspecified