Basic Information
| Provider Information | |||||||||
| NPI: | 1669738654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HECKMAN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 FORESTVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | ELKLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169201403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142585117 | ||||||||
| FaxNumber: | 8142585510 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 FORESTVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | ELKLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169201403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142585117 | ||||||||
| FaxNumber: | 8142585510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2012 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 281344-1 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD458866 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.