Healthcare Provider Details

I. General information

NPI: 1043066616
Provider Name (Legal Business Name): MICHAEL VINCENT HEILMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 ATLANTIC AVE STE 101
OCEAN VIEW DE
19970-9103
US

IV. Provider business mailing address

10026 OLD OCEAN CITY BLVD
BERLIN MD
21811-9515
US

V. Phone/Fax

Practice location:
  • Phone: 302-541-4460
  • Fax: 302-541-0124
Mailing address:
  • Phone: 410-641-9450
  • Fax: 410-641-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC5-0012057
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009370
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0009370
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012057
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: