Provider Demographics
NPI:1306286596
Name:HEURICH, MAUREEN ELIZABETH (DPM)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:HEURICH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ELIZABETH
Other - Last Name:ALLANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:3578 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3143
Mailing Address - Country:US
Mailing Address - Phone:724-775-6168
Mailing Address - Fax:
Practice Address - Street 1:1002 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2325
Practice Address - Country:US
Practice Address - Phone:724-775-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASC006704213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA500448WMFMedicaid