Provider Demographics
NPI:1699937748
Name:CARNEY, HEATHER MARY (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARY
Last Name:CARNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3911
Mailing Address - Country:US
Mailing Address - Phone:301-255-4023
Mailing Address - Fax:
Practice Address - Street 1:6111 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3911
Practice Address - Country:US
Practice Address - Phone:301-255-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD045643207ZP0102X
VA0101263405207ZP0102X
MDD0084013207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17157871Medicaid
MD357148300Medicaid
VA1699937748Medicaid
CT1699937748Medicaid