Provider Demographics
NPI:1063621290
Name:MOURTACOS, HEATHER (DO)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:MOURTACOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MULTARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 ELLIOT RD
Mailing Address - Street 2:
Mailing Address - City:WEST MIDDLESEX
Mailing Address - State:PA
Mailing Address - Zip Code:16159-2003
Mailing Address - Country:US
Mailing Address - Phone:412-527-8105
Mailing Address - Fax:
Practice Address - Street 1:631 N BROAD STREET EXT
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4603
Practice Address - Country:US
Practice Address - Phone:724-450-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012768CTR2083A0300X, 208D00000X
PAOS013888207LA0401X, 208D00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice