Healthcare Provider Details

I. General information

NPI: 1619654241
Provider Name (Legal Business Name): MARY CAITLIN SAMUELS HEINTZELMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 ANDREW DR STE 100
WEST CHESTER PA
19380-3446
US

IV. Provider business mailing address

140 W GERMANTOWN PIKE STE 200
PLYMOUTH MEETING PA
19462-1421
US

V. Phone/Fax

Practice location:
  • Phone: 610-692-4270
  • Fax:
Mailing address:
  • Phone: 484-530-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13445
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: