Provider Demographics
NPI:1134179278
Name:HEIMANN, MARK (CRNP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HEIMANN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLR CARDIOLOGY CONSULTANTS OF PHILA
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-462-7100
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:1330 POWELL ST
Practice Address - Street 2:SUITE 301 CARDIOLOGY CONSULTANTS OF PHILA
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401
Practice Address - Country:US
Practice Address - Phone:610-272-3253
Practice Address - Fax:610-272-8826
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003622P363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVP003622POtherCRNP LICENSE