Healthcare Provider Details

I. General information

NPI: 1912151143
Provider Name (Legal Business Name): HERITAGE MEDICAL GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WALNUT ST SUITE 100
LEMOYNE PA
17043-1168
US

IV. Provider business mailing address

3 WALNUT ST SUITE 206
LEMOYNE PA
17043-1168
US

V. Phone/Fax

Practice location:
  • Phone: 717-737-3037
  • Fax: 717-909-0912
Mailing address:
  • Phone: 717-761-0208
  • Fax: 717-761-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH A. CINCOTTA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 717-761-0208