Provider Demographics
NPI:1457382269
Name:HEIL, BRIAN VASSAR (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:VASSAR
Last Name:HEIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:V
Other - Last Name:HEIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:144 EMERYVILLE DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066
Mailing Address - Country:US
Mailing Address - Phone:724-776-2111
Mailing Address - Fax:724-776-2199
Practice Address - Street 1:144 EMERYVILLE DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-776-2111
Practice Address - Fax:724-776-2199
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067639L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018490370005Medicaid
PA908731OtherHIGHMARK
PA908731OtherHIGHMARK
H35048Medicare UPIN