Provider Demographics
NPI:1194994053
Name:NEUTZE-HEANEY, KIMBERLY ANN (DO)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:NEUTZE-HEANEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:NEUTZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2023 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2137
Mailing Address - Country:US
Mailing Address - Phone:410-939-6477
Mailing Address - Fax:410-939-6555
Practice Address - Street 1:2023 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2137
Practice Address - Country:US
Practice Address - Phone:410-939-6477
Practice Address - Fax:410-939-6555
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0075167207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD336833500Medicaid