Provider Demographics
NPI:1295774503
Name:LOCKNER, HEATHER L (DO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:LOCKNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CREAMERY WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2551
Mailing Address - Country:US
Mailing Address - Phone:610-594-7590
Mailing Address - Fax:610-594-2625
Practice Address - Street 1:520 MAPLE AVE STE 4
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4434
Practice Address - Country:US
Practice Address - Phone:610-430-8200
Practice Address - Fax:610-594-2625
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101380909Medicaid
091703Medicare PIN
PA101380909Medicaid