MEDICARE: BRAD ROBERT HEINZ PH D

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
1	103T00000X	Psychologist	1478	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0358A	OTHER	NC	BLUE CROSS BLUE SHIELD OF NORTH CAROLINA

General Provider Information

NPI Number	:	1467430348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD ROBERT HEINZ PH D

Provider Business Mailing Address
First Line	:	1556 LAMONT NORWOOD RD
Second Line	:
City	:	PITTSBORO
State	:	NC
Zip	:	27312-7194
Country	:	US
Telephone Number	:	919-929-8379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1556 LAMONT NORWOOD RD
Second Line	:
City	:	PITTSBORO
State	:	NC
Zip	:	27312-7194
Country	:	US
Telephone Number	:	919-929-8379
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	04/02/2015

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Directions to “ BRAD ROBERT HEINZ PH D” Practice Location

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