Provider Demographics
NPI:1609304385
Name:BHADRA-HEINTZ, NIA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIA
Middle Name:
Last Name:BHADRA-HEINTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 MARKET ST
Mailing Address - Street 2:3RD FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5502
Mailing Address - Country:US
Mailing Address - Phone:215-662-6035
Mailing Address - Fax:215-349-5228
Practice Address - Street 1:3701 MARKET ST
Practice Address - Street 2:3RD FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5502
Practice Address - Country:US
Practice Address - Phone:215-662-6035
Practice Address - Fax:215-349-5228
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD478128207V00000X
390200000X
OH35.142993207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program