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General NPI Number Information
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NPI Number | 1326675802
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Entity Type | Individual
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Provider Name | MICHAEL HEFFERNAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 278 EAGLEVIEW BLVD
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City | EXTON
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State | PA
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Zip | 19341-1157
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Country | US
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Telephone | 610-561-6320
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Fax | 610-561-6301
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Provider Business Mailing Address
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Address Line | 39 COLLEGE AVE
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City | FLOURTOWN
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State | PA
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Zip | 19031-1930
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Country | US
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Telephone | 267-625-8210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA061447
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License Number State | PA
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