Provider Demographics
NPI:1588897326
Name:HEAGEY, PATRICK E (PA)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:E
Last Name:HEAGEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SYCAMORE CIR
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1816
Mailing Address - Country:US
Mailing Address - Phone:717-476-9682
Mailing Address - Fax:
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:484-565-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2012-02-14
Deactivation Date:2009-09-08
Deactivation Code:
Reactivation Date:2009-09-25
Provider Licenses
StateLicense IDTaxonomies
PAMA054099363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant