Provider Demographics
NPI:1154869378
Name:HECKHAUS, LAUREN R (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:R
Last Name:HECKHAUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:85 THOMAS JOHNSON CT SUITE C
Mailing Address - Street 2:INTERNAL MEDICINE SPECIALISTS OF FREDERICK
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-668-9393
Mailing Address - Fax:301-668-4480
Practice Address - Street 1:19 W FREDERICK ST
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-8230
Practice Address - Country:US
Practice Address - Phone:301-846-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant