Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS018340 | PA |
NPI | 1003251620 |
---|---|
Provider Name | Matthew Heitzenrater |
First Address | Erie, PA 16506-3064 |
Second Address | Erie, PA 16506-3064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2013 |
Last Update Date | 24/05/2021 |