Healthcare Provider Details

I. General information

NPI: 1003842287
Provider Name (Legal Business Name): DONNA MARIE HEFFERNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 EAST RD
TROY NY
12180-6860
US

IV. Provider business mailing address

PO BOX 3203
SCHENECTADY NY
12303-0203
US

V. Phone/Fax

Practice location:
  • Phone: 518-346-3100
  • Fax: 877-583-1284
Mailing address:
  • Phone: 518-346-3100
  • Fax: 518-688-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2272751
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number227275
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: