=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417278912
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIKA M HEGLAND DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2010
-----------------------------------------------------
Last Update Date | 02/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 BRITTONFIELD PKWY STE A124
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-9215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-218-0430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2003
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-4503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-362-5129
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 271536
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------