1336898303 NPI number — DONNA HEFFERNAN MD PLLC

Table of content: (NPI 1336898303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336898303 NPI number — DONNA HEFFERNAN MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONNA HEFFERNAN MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336898303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12303-0203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-346-3100
Provider Business Mailing Address Fax Number:
877-583-1284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 EAST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180-6860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-346-3100
Provider Business Practice Location Address Fax Number:
877-583-1284
Provider Enumeration Date:
03/18/2022

Additional Information

Authorized Official

Authorized Official Last Name:
STEVENSON
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
518-346-3100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1336898303 . This is a "HIGHMARK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1336898303 . This is a "GEHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1336898303 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1336898303 . This is a "WELLCARE AMERICAN PROGRESSIVE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1336898303 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02425056 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1336898303 . This is a "MVP HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1336898303 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01666792112180000 . This is a "TRICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1336898303 . This is a "EMBLEM HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1336898303 . This is a "HUMANA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1336898303 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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