Provider Demographics
NPI:1093700460
Name:HEFFNER, ALAN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:CHRISTOPHER
Last Name:HEFFNER
Suffix:
Gender:M
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 S KINGS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2134
Practice Address - Country:US
Practice Address - Phone:704-446-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800898207P00000X, 207R00000X, 207RC0200X, 207RP1001X, 207RC0200X
PAMD426091207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN0089HMedicaid
NC89127YXMedicaid
NC1093700460Medicaid
NC127YXOtherNCBCBS
VA0101-227463OtherMEDICAL LIC NUMBER
PAMD426091OtherMED LIC NUMBER
NC2279713CMedicare PIN
NC89127YXMedicaid
PAMD426091OtherMED LIC NUMBER
NC1093700460Medicaid