1457382269 NPI number — BRIAN VASSAR HEIL MD

Table of content: BRIAN VASSAR HEIL MD (NPI 1457382269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457382269 NPI number — BRIAN VASSAR HEIL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIL
Provider First Name:
BRIAN
Provider Middle Name:
VASSAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEIL
Provider Other First Name:
BRIAN
Provider Other Middle Name:
V
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1457382269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 EMERYVILLE DRIVE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
CRANBERRY TOWNSHIP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-776-2111
Provider Business Mailing Address Fax Number:
724-776-2199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 EMERYVILLE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
CRANBERRY TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-776-2111
Provider Business Practice Location Address Fax Number:
724-776-2199
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  MD067639L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0018490370005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 908731 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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