Provider Demographics
NPI:1265412092
Name:SMITH, HEATHER J (DO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:J
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:41 UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:1609 WOODBOURNE RD STE 101
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057
Practice Address - Country:US
Practice Address - Phone:215-945-1500
Practice Address - Fax:215-945-9192
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005751L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4205346OtherAETNA PPO
PA0011327660002Medicaid
PA0082923000OtherKEYSTONE EAST
PA137311OtherHIGHMARK BLUE SHIELD
PA30080581OtherKEYSTONE FIRST
PAP00895494OtherRAILROAD MEDICARE
PA118864300OtherU.S. DEPT. OF LABOR
PA1222543002OtherCIGNA PROVIDER ID
PA19252OtherUMWA
PA192525879OtherTRICARE
PA96496OtherOPERATOR'S 825 WELFARE
PA137311OtherHIGHMARK BLUE SHIELD
PA137311R52Medicare PIN
PAOS005751LOtherSTATE LICENSE
PA1084097OtherKEYSTONE MERCY
PA2Y1928OtherHEALTHNET
PA118864300OtherU.S. DEPT. OF LABOR