Provider Demographics
NPI:1891971933
Name:HEINO, WILLIAM J JR (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:HEINO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 824339
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4339
Mailing Address - Country:US
Mailing Address - Phone:866-709-4485
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:25500 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2015
Practice Address - Country:US
Practice Address - Phone:301-475-6204
Practice Address - Fax:301-997-6507
Is Sole Proprietor?:No
Enumeration Date:2008-01-19
Last Update Date:2013-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY234373207L00000X, 207Q00000X, 207LC0200X
CT047202207L00000X, 207Q00000X, 207LP3000X
MDH0076579207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY129286Medicare UPIN