Provider Demographics
NPI:1932272002
Name:HELLER, DANIEL NOAH (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:NOAH
Last Name:HELLER
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:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1900
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-761-4201
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1622592085R0202X
WAMD000393962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500671168Medicaid
WA1022639OtherLNI-UNION AVENUE OPEN MRI
WA0146967OtherLNI-TRA
WA1022639Medicaid
WA146966OtherLABOR AND INDUSTRIES/WC UNION AVENUE OPEN
WA300119673OtherRR MEDICARE UNION AVENUE OPEN
WA8929712OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WAGAB20888OtherPTAN-TRA PIERCE CO
WA8951831OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WA8210403Medicaid
WAG8881688OtherPTAN-MIO1
WAGAB20890OtherPTAN-UAOM
WA170313OtherLABOR AND INDUSTRIES/WC ADVANCED OPEN IMAGING
WA3231HEOtherREGENCE BLUE SHIELD TRA
WA7252HEOtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WA146967OtherLABOR AND INDUSTRIES/WC TRA
WAAB36524OtherMEDICARE PIN TRA KING COUNTY
WAGAB20890OtherPTAN-UAOM
WAAB37888OtherMEDICARE PIN ADVANCED OPEN IMAGING
WA3231HEOtherREGENCE BLUE SHIELD TRA
WAOO1055602Medicare ID - Type UnspecifiedTACOMA RADIOLOGICAL ASSOC