Provider Demographics
NPI:1093752396
Name:HEFLIN, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HEFLIN
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 1:765 LIBERTY ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2566
Mailing Address - Country:US
Mailing Address - Phone:814-333-5009
Mailing Address - Fax:814-333-5120
Practice Address - Street 1:765 LIBERTY ST
Practice Address - Street 2:SUITE 209
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2566
Practice Address - Country:US
Practice Address - Phone:814-333-5009
Practice Address - Fax:814-333-5120
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050852L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018529090008Medicaid
PA0018529090008Medicaid
PAH46279Medicare UPIN