MEDICARE: JANE M HEANEY DO PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS 005958-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2258275001	OTHER	PA	KEYSTONE
2	4547198	OTHER	PA	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659578151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE M HEANEY DO PC

Provider Business Mailing Address
First Line	:	4000 GYPSY LN UNIT 405
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-5426
Country	:	US
Telephone Number	:	215-848-4062
Fax Number	:	215-848-4552

Provider Business Practice Location Address
First Line	:	110 LEVERING ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-1404
Country	:	US
Telephone Number	:	215-483-7200
Fax Number	:	215-483-2122

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	JANE M HEANEY
Credential	:	D.O.
Telephone Number	:	215-483-7200

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	08/22/2020

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