Healthcare Provider Details

I. General information

NPI: 1902298771
Provider Name (Legal Business Name): MOLLY BETH HEIPLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY PETERLIN

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLZ
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

1 FEDERAL ST STE 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 800-826-6737
  • Fax:
Mailing address:
  • Phone: 848-288-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA057430
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP01009700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: