Provider Demographics
NPI:1255140596
Name:HEISER, DANIEL (RRA RT(R) VI)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HEISER
Suffix:
Gender:M
Credentials:RRA RT(R) VI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:441 S DILLARD ST APT 102
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4946
Mailing Address - Country:US
Mailing Address - Phone:571-213-1702
Mailing Address - Fax:
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:646-846-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4482282471V0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional Technology