Provider Demographics
NPI:1003842287
Name:HEFFERNAN, DONNA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:HEFFERNAN
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:PO BOX 3203
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-0203
Mailing Address - Country:US
Mailing Address - Phone:518-346-3100
Mailing Address - Fax:518-688-1342
Practice Address - Street 1:16 CRIMSON OAK CT
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-2234
Practice Address - Country:US
Practice Address - Phone:518-346-3100
Practice Address - Fax:518-688-1342
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5191C1OtherEMPIRE BC
NY10072104OtherCDPHP
NY000404017001OtherBSNENY
NY200048OtherSENIOR WHOLE HEALTH
NY74563OtherGHI/HMO
NY394892OtherMVP
NY070223000110OtherFIDELIS
NY02425056Medicaid
NY7309558OtherAETNA
NY02425056Medicaid
NYH83783Medicare UPIN