Basic Information
| Provider Information | |||||||||
| NPI: | 1972518785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEYAT | ||||||||
| FirstName: | PERVIZ | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1430 | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228031430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405645791 | ||||||||
| FaxNumber: | 5405647038 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 CANTRELL AVE | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228013248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405647364 | ||||||||
| FaxNumber: | 5405647365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 04/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101058911 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0073414000 | 01 | WV | WV MEDICAID | OTHER | 1000870001 | 01 | VA | DME PROVIDER | OTHER | 5844100 | 05 | VA | MEDICAID | 310230 | 01 | SOUTHERN HEALTH | OTHER | 185401 | 01 | ANTHEM/BCBS | OTHER | 20632 | 01 | VA | OPTIMA | OTHER |