Healthcare Provider Details

I. General information

NPI: 1417578733
Provider Name (Legal Business Name): ALYCIA PAIGE HEINER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYCIA PAIGE LEE DO

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARKSIDE HEALTH CENTER 765 KENILWORTH TERRACE NE
WASHINGTON DC
20019
US

IV. Provider business mailing address

501 S WASHINGTON AVE
SCRANTON PA
18505-3814
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-8183
  • Fax: 202-548-8600
Mailing address:
  • Phone: 570-343-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: