Provider Demographics
NPI:1689639445
Name:BROWN, HEATHER LYNNE (PAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNNE
Other - Last Name:BICKLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 OWENSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:20778-9998
Mailing Address - Country:US
Mailing Address - Phone:410-867-4700
Mailing Address - Fax:
Practice Address - Street 1:134 OWENSVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST RIVER
Practice Address - State:MD
Practice Address - Zip Code:20778-9998
Practice Address - Country:US
Practice Address - Phone:410-867-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC 2302363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD970022986OtherRAILROAD MEDICARE
MDP24119Medicare UPIN
MD970022986OtherRAILROAD MEDICARE