Healthcare Provider Details

I. General information

NPI: 1174503940
Provider Name (Legal Business Name): BRADLEY W. HEFFNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N 7TH ST
CHAMBERSBURG PA
17201-1720
US

IV. Provider business mailing address

785 5TH AVE STE 3
CHAMBERSBURG PA
17201-4232
US

V. Phone/Fax

Practice location:
  • Phone: 717-267-7164
  • Fax: 717-267-7414
Mailing address:
  • Phone: 717-263-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD68209
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101233096
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA102127
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD439330
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: