Provider Demographics
NPI:1417578733
Name:HEINER, ALYCIA PAIGE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALYCIA
Middle Name:PAIGE
Last Name:HEINER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ALYCIA
Other - Middle Name:PAIGE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:501 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-3814
Mailing Address - Country:US
Mailing Address - Phone:570-343-2383
Mailing Address - Fax:
Practice Address - Street 1:PARKSIDE HEALTH CENTER
Practice Address - Street 2:765 KENILWORTH TERRACE NE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019
Practice Address - Country:US
Practice Address - Phone:202-388-8183
Practice Address - Fax:202-548-8600
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program