Provider Demographics
NPI:1558701276
Name:HEANEY, ASHLEY IVKOVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:IVKOVICH
Last Name:HEANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:376 W 10TH AVE
Mailing Address - Street 2:776 PRIOR HALL
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1280
Mailing Address - Country:US
Mailing Address - Phone:614-293-3551
Mailing Address - Fax:614-293-3124
Practice Address - Street 1:376 W 10TH AVE
Practice Address - Street 2:776 PRIOR HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1280
Practice Address - Country:US
Practice Address - Phone:614-293-3551
Practice Address - Fax:614-293-3124
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH127090207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program