Healthcare Provider Details

I. General information

NPI: 1336898303
Provider Name (Legal Business Name): DONNA HEFFERNAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
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: 877-583-1284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA A STEVENSON
Title or Position: PRACTICE MANAGER
Credential: MD
Phone: 518-346-3100