Provider Demographics
NPI:1669738654
Name:HECKMAN, MATTHEW P (MD, PHD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:HECKMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FORESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ELKLAND
Mailing Address - State:PA
Mailing Address - Zip Code:16920-1403
Mailing Address - Country:US
Mailing Address - Phone:814-258-5117
Mailing Address - Fax:814-258-5510
Practice Address - Street 1:103 FORESTVIEW AVE
Practice Address - Street 2:
Practice Address - City:ELKLAND
Practice Address - State:PA
Practice Address - Zip Code:16920-1403
Practice Address - Country:US
Practice Address - Phone:814-258-5117
Practice Address - Fax:814-258-5510
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281344-1207Q00000X
PAMD458866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine