Provider Demographics
NPI:1396717815
Name:HEFFNER, GEORGE WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAM
Last Name:HEFFNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:
Practice Address - Street 1:106 S CLAUDE A LORD BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3637
Practice Address - Country:US
Practice Address - Phone:570-622-4209
Practice Address - Fax:570-622-1386
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038172E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000139952OtherBLUE SHIELD
PA110076984OtherRAILROAD MEDICARE PBA
PA116993900OtherFEDERAL EMPLOYEES COMP
PA0011473840002Medicaid
PA01623701OtherCAPITAL BLUE CROSS
PA0473231OtherUS HEALTHCARE
PA10866OtherGEISINGER HEALTH PLAN
PA0998130OtherKEYSTONE SPECIALIST
PA203010OtherFEDERAL BLACK LUNG
PA01623701OtherKEYSTONE
PA0473231OtherUS HEALTHCARE
B38985Medicare UPIN