Provider Demographics
NPI:1801022488
Name:HEABERLIN, MARTA E (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:E
Last Name:HEABERLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:E
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:734 N 3RD ST STE 115
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5287
Mailing Address - Country:US
Mailing Address - Phone:352-365-2583
Mailing Address - Fax:352-728-6749
Practice Address - Street 1:1400 N US HIGHWAY 441 STE 510
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8983
Practice Address - Country:US
Practice Address - Phone:352-787-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1173472085R0202X
VA01095420742085R0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program