Provider Demographics
NPI:1093770398
Name:HIEMENZ, DONALD W (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:HIEMENZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:RODENBACH LANE
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-9900
Mailing Address - Country:US
Mailing Address - Phone:570-992-4202
Mailing Address - Fax:570-992-6117
Practice Address - Street 1:RODENBACH LANE
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322
Practice Address - Country:US
Practice Address - Phone:570-992-4208
Practice Address - Fax:570-992-6117
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD013429E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007282060002Medicaid
PAB36371Medicare UPIN
PA0007282060002Medicaid