Healthcare Provider Details

I. General information

NPI: 1295124519
Provider Name (Legal Business Name): MR. DAVE HECKARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID HECKARD M.S.

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S 9TH ST
LEBANON PA
17042-5104
US

IV. Provider business mailing address

12 ASPEN WAY
LEBANON PA
17046-1864
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-5992
  • Fax:
Mailing address:
  • Phone: 717-222-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberBH002571
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: