Provider Demographics
NPI:1801836705
Name:HEILAND, KELLY D (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:D
Last Name:HEILAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4453 CASTOR AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3846
Mailing Address - Country:US
Mailing Address - Phone:215-744-2266
Mailing Address - Fax:215-743-9247
Practice Address - Street 1:4453 CASTOR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3846
Practice Address - Country:US
Practice Address - Phone:215-744-2266
Practice Address - Fax:215-743-9247
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012295207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I53276Medicare UPIN
101417R2LMedicare PIN