Provider Demographics
NPI:1174503940
Name:HEFFNER, BRADLEY W (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
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 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7164
Practice Address - Fax:717-267-7414
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD68209207L00000X
VA0101233096207L00000X
CAA102127207L00000X
PAMD439330207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1587829OtherGATEWAY HEALTH PLAN
PA30075072OtherAMERIHEALTH MERCY-WMG
PA102371056Medicaid
PA2115002OtherHIGHMARK BLUE SHIELD
PA301005OtherUNISON-WMG
PA415765OtherUPMC-WMG
PA2115002OtherHIGHMARK BLUE SHIELD
PAP00930856Medicare PIN
PA102371056Medicaid