Provider Demographics
NPI:1902912033
Name:KIND-WOLF, HEIDI KIND (DO)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:KIND
Last Name:KIND-WOLF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 CANDLERS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2287
Mailing Address - Country:US
Mailing Address - Phone:434-239-3949
Mailing Address - Fax:434-239-6982
Practice Address - Street 1:2832 CANDLERS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2287
Practice Address - Country:US
Practice Address - Phone:434-239-3949
Practice Address - Fax:434-239-6982
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F46916Medicare UPIN
VA006719P17Medicare ID - Type Unspecified