Provider Demographics
NPI:1336111608
Name:HEINE, MARK DIETER (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DIETER
Last Name:HEINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4004 BEN FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704
Mailing Address - Country:US
Mailing Address - Phone:919-479-1600
Mailing Address - Fax:919-479-5551
Practice Address - Street 1:4004 BEN FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:919-479-1600
Practice Address - Fax:919-479-5551
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC335932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry