Provider Demographics
NPI:1730133869
Name:YUTZLER-OVERTON, HEIDI J (DO)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:YUTZLER-OVERTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 789967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9967
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:721 SKIPPACK PIKE
Practice Address - Street 2:SUITE 3
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1700
Practice Address - Country:US
Practice Address - Phone:215-793-0600
Practice Address - Fax:215-793-0759
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009299L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1085098OtherKEYSTONE MERCY
PA124902OtherHIGHMARK BLUE SHIELD
PA2972798OtherCIGNA HMP/PPO
PA0017470460001Medicaid
PA33022-OS009299LOtherHEALTH PARTNERS
PA0174704602OtherAMERICHOICE (UHC MA PLAN)
PA0294553000OtherAMERIHEALTH/INTERCOUNTY
PA5809719OtherAETNA PPO
PA2120908OtherALLIANCE/OPT CHC (MAMSI)
PA0294553000OtherIBC - PC/KHPE
PA9061935OtherPHCS
PA10939224OtherCAQH ID#
PA2152221OtherAETNA HMO
PA080139151OtherRRM
PA2152221OtherAETNA HMO