Provider Demographics
NPI:1821433921
Name:HEIPLE, BRADLEY W (DO)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:HEIPLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PENN LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:PA
Mailing Address - Zip Code:15126-9772
Mailing Address - Country:US
Mailing Address - Phone:724-773-3001
Mailing Address - Fax:724-773-4872
Practice Address - Street 1:300 PENN LINCOLN DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:PA
Practice Address - Zip Code:15126-9772
Practice Address - Country:US
Practice Address - Phone:724-773-3001
Practice Address - Fax:724-773-4872
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015277207Q00000X
PAOS017719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine