Provider Demographics
NPI:1881783827
Name:HEITLINGER, LEO (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:HEITLINGER
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 1:701 OSTRUM ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:484-526-7575
Mailing Address - Fax:484-526-7570
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:484-526-7575
Practice Address - Fax:484-526-7570
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD0698822080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001039770Medicaid
PWE29816Medicare UPIN
PA001039770Medicaid