Provider Demographics
NPI:1952360398
Name:GIDES, HEATHER A (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:GIDES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:HALLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:322 WARREN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3443
Mailing Address - Country:US
Mailing Address - Phone:814-288-4498
Mailing Address - Fax:814-288-5427
Practice Address - Street 1:322 WARREN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3443
Practice Address - Country:US
Practice Address - Phone:814-288-4498
Practice Address - Fax:814-288-5427
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051736363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q66414Medicare UPIN
PA099606Medicare ID - Type Unspecified