Provider Demographics
NPI:1750381133
Name:HEYD, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HEYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012011208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA169239OtherUNISON
PA1487870OtherBLUE SHIELD
PA323032OtherUPMC
NY00027257401OtherUNIVERA
PA1533787OtherGATEWAY
NY02664542OtherNY MEDICAL ASSISTANCE
PA7104722OtherAETNA
PA0019580780003Medicaid
WV1068818OtherW. VIRGINIA WORKERS COMP
OH2583655OtherOH MEDICAL ASSISTANCE
PAP00230475OtherRR MEDICARE
OH2583655OtherOH MEDICAL ASSISTANCE
PA0019580780003Medicaid