Healthcare Provider Details

I. General information

NPI: 1326134768
Provider Name (Legal Business Name): PATRICK HEAGHNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 SHERMAN DR
ST JOHNSBURY VT
05819-9811
US

IV. Provider business mailing address

PO BOX 461
JOHNSON VT
05656-0461
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-9405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number042-0009083
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0420009083
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042.0009083
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: