Provider Demographics
NPI:1942269303
Name:HEPPNER, BRADLEY
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:HEPPNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LOTHROP STREET UPMC PHYSICIAN SERVICES
Mailing Address - Street 2:SUITE 3010
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 DELAFIELD RD
Practice Address - Street 2:SUITE 3010
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3205
Practice Address - Country:US
Practice Address - Phone:412-781-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046352L207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012852550006Medicaid
OH0890906Medicaid
PA001285255Medicaid
PA0012852550004Medicaid
PA0012852550010Medicaid
WV0085904000Medicaid
PA001285255Medicaid
PA714307YBOTMedicare PIN
PAP00895598Medicare PIN
PA714307R7RMedicare PIN
PAF20146Medicare UPIN
PA0012852550010Medicaid
PA060046791Medicare PIN
PA714307DXCMedicare PIN