Healthcare Provider Details

I. General information

NPI: 1295774503
Provider Name (Legal Business Name): HEATHER L LOCKNER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CHESTERBROOK BLVD
BERWYN PA
19312-3805
US

IV. Provider business mailing address

1001 CHESTERBROOK BLVD
BERWYN PA
19312-3805
US

V. Phone/Fax

Practice location:
  • Phone: 610-576-7515
  • Fax:
Mailing address:
  • Phone: 610-576-7515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS012393
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: