Healthcare Provider Details

I. General information

NPI: 1699421925
Provider Name (Legal Business Name): HEATHER MARIE JAHODA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MARIE GORMAN PA-C

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

1025 HICKORY LN
READING PA
19606-2467
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-7692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA063370
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: