Healthcare Provider Details

I. General information

NPI: 1487158861
Provider Name (Legal Business Name): JOSEPH HEINEMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 07/19/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W BELVEDERE AVE STE 205
BALTIMORE MD
21215-5229
US

IV. Provider business mailing address

6510 WICKFIELD RD
BALTIMORE MD
21209-2545
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-8331
  • Fax: 410-601-8859
Mailing address:
  • Phone: 973-271-4704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0091523
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberD0091523
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: