Basic Information
| Provider Information | |||||||||
| NPI: | 1679928055 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEINO | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 SEVENTH ST | ||||||||
| Address2: | |||||||||
| City: | NEW KENSINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150686529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243393900 | ||||||||
| FaxNumber: | 7243341704 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 SEVENTH ST | ||||||||
| Address2: | |||||||||
| City: | NEW KENSINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150686529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243393900 | ||||||||
| FaxNumber: | 7243341704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2016 | ||||||||
| LastUpdateDate: | 12/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD468386 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.