Provider Demographics
NPI:1316938707
Name:HEYRICH, GEORGE PATRICK (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PATRICK
Last Name:HEYRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PHEASANT RUN
Mailing Address - Street 2:SUITE 128
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3439
Mailing Address - Country:US
Mailing Address - Phone:215-860-3344
Mailing Address - Fax:215-860-8950
Practice Address - Street 1:104 PHEASANT RUN
Practice Address - Street 2:SUITE 128
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3439
Practice Address - Country:US
Practice Address - Phone:215-860-3344
Practice Address - Fax:215-860-8950
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045709L207RI0011X
NJ25MA06408100207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0072646370002Medicaid
NJ6985408Medicaid
NJ462009036OtherTIN
NJ223505477OtherTIN
PA0072646370002Medicaid
PA232571699OtherTIN
PA718577Medicare PIN
F23268Medicare UPIN
PA718577LWHMedicare PIN
PA223505477OtherTIN