Provider Demographics
NPI:1699983692
Name:HENIG, HEATHER KILBRIDE (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:KILBRIDE
Last Name:HENIG
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 1:1314A KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4513
Mailing Address - Country:US
Mailing Address - Phone:256-293-9283
Mailing Address - Fax:
Practice Address - Street 1:11490 COMMERCE PARK DR STE 420
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191
Practice Address - Country:US
Practice Address - Phone:703-481-9111
Practice Address - Fax:703-707-8657
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012443432084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL113205Medicaid