Provider Demographics
NPI:1629178314
Name:HEADLY, ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:HEADLY
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 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-342-2439
Mailing Address - Fax:856-966-0735
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 215
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2439
Practice Address - Fax:856-966-0735
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA74930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8959200Medicaid
P2795627OtherOXFORD
36607OtherUNIVERSITY HEALTHPLAN
1472136OtherAMERIHEALTH PPO
1167971OtherHORIZON NJ HEALTH
3K3532OtherHEALTHNET
PA1472136OtherPA BLUE SHIELD
2255382OtherUNITED HEALTHCARE
0000094090OtherOPERATING ENGINEER LOCAL
010004725 00OtherAMERICHOICE
3065361OtherAETNA US-HEALTHCARE
9855308OtherCIGNA
110243929OtherRR MEDICARE
2155659000OtherAMERIHEALTH, HMO, KEYSTONE, IBC
3065361OtherAETNA US-HEALTHCARE
NJ064299Medicare PIN