Healthcare Provider Details

I. General information

NPI: 1437509676
Provider Name (Legal Business Name): BROOKE NICOLE HEYMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2016
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST. 3 RAVDIN BLDG STE F
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

3400 SPRUCE ST. 3 RAVDIN BLDG STE F
PHILADELPHIA PA
19104-4206
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3202
  • Fax: 215-349-8432
Mailing address:
  • Phone: 215-662-3202
  • Fax: 215-349-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD477802
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD477802
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD477802
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: