Healthcare Provider Details

I. General information

NPI: 1114956018
Provider Name (Legal Business Name): CATHERINE BOOTH HEILMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE MARIE BOOTH

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 4TH ST
EAST BERLIN PA
17316-9638
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-4900
  • Fax: 717-255-0951
Mailing address:
  • Phone: 717-812-4900
  • Fax: 717-259-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD054335L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: