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NPI Code Detail

MEDICARE: HEIDI L BOERMAN PA-C, ATC

MEDICARE: HEIDI L BOERMAN PA-C, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant001455CT
2363A00000XPhysician Assistant0110001442VA

General Provider Information

NPI Number : 1427048412
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI L BOERMAN PA-C, ATC
Provider Business Mailing Address
First Line : USA MEDDAC ATTN: CREDENTIALS
Second Line : 11050 MT BELVEDERE BLVD
City : FORT DRUM
State : NY
Zip : 13602-5004
Country : US
Telephone Number : 315-772-4025
Fax Number : 315-772-9498
Provider Business Practice Location Address
First Line : USA MEDDAC ATTN: CREDENTIALS
Second Line : 11050 MT BELVEDERE BLVD
City : FORT DRUM
State : NY
Zip : 13602-5004
Country : US
Telephone Number : 315-772-4025
Fax Number : 315-772-9498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 09/11/2025

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