Provider Demographics
NPI:1558324863
Name:HEINE, LAURICE ANN (MD)
Entity Type:Individual
Prefix:
First Name:LAURICE
Middle Name:ANN
Last Name:HEINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
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:717-217-4217
Practice Address - Street 1:12 ST PAUL DR STE 207
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1035
Practice Address - Country:US
Practice Address - Phone:717-217-6882
Practice Address - Fax:717-217-6883
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048664L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120420413OtherDEPT OF LABOR
PA50063263OtherCAPITAL BLUECROSS
PA25-1716306OtherHEALTHNET/TRICARE
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA440483OtherHEALTH AMERICA
PAG920-0089/KV77CUOtherCAREFIRST
PA1559522OtherGATEWAY
PA186916OtherUNISON
PA25-1716306OtherINTERGROUP
PA4532284OtherAETNA NON-HMO
PA770645OtherHIGHMARK BLUE SHIELD
PAP00377944OtherRAILROAD MEDICARE
PA1360595OtherAETNA HMO
PA25-1716306OtherINFORMED
PA25-1716306OtherDEVON
PAMD048664LOtherLICENSE
PA001462153 0002Medicaid
PA237267OtherMAMSI
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherFIRST HEALTH
PA867633OtherMEDICARE GROUP #
PA867633OtherMEDICARE GROUP #
PA25-1716306OtherHEALTHNET/TRICARE
PA770645LN7Medicare PIN