Heitzman, Mark Robert

Heitzman, Mark Robert is an individual health care provider with primary practice located at 130 Fisher Rd Mob-A Suite 2-1, Berlin VT 05602-9516. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Cardiology, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Cardiovascular Disease is his primary health care specialty. Heitzman, Mark Robert can be contacted via phone (802) 225-5660.

Contact Information

Primary practice address
130 Fisher Rd Mob-A Suite 2-1 Berlin VT 05602-9516
Phone: (802) 225-5660
Fax: (802) 229-2533
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 420006618 Vermont
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 042.0006618 Vermont

Profile Details

NPI number 1790704401
LBN Legal business name Heitzman, Mark Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2006
Last updated Dec 4th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790704401 NPPES
Vermont MEDICAID 0005341
Vermont Other P01125405
Vermont Other 060014973

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