Provider Demographics
NPI:1669431334
Name:HEINY, LAWRENCE P (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:P
Last Name:HEINY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N CLEVELAND AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9846
Mailing Address - Country:US
Mailing Address - Phone:614-891-4705
Mailing Address - Fax:614-568-8050
Practice Address - Street 1:540 N CLEVELAND AVE STE 250
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9846
Practice Address - Country:US
Practice Address - Phone:614-891-4705
Practice Address - Fax:614-568-8050
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.036602208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0249494Medicaid