Healthcare Provider Details

I. General information

NPI: 1689621401
Provider Name (Legal Business Name): HERITAGE VALLEY PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 COLLEGE AVE
BEAVER PA
15009-2706
US

IV. Provider business mailing address

2 PEARTREE WAY
BEAVER PA
15009-1954
US

V. Phone/Fax

Practice location:
  • Phone: 724-774-4070
  • Fax: 724-774-2872
Mailing address:
  • Phone: 724-773-6802
  • Fax: 724-770-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. NORMAN F MITRY
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 724-773-4779