Provider Demographics
NPI:1720285752
Name:HEINZ, KRISTANN WILMORE (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTANN
Middle Name:WILMORE
Last Name:HEINZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SHERMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:OTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18942
Mailing Address - Country:US
Mailing Address - Phone:610-847-1111
Mailing Address - Fax:215-278-4051
Practice Address - Street 1:85 SHERMAN ROAD
Practice Address - Street 2:
Practice Address - City:OTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18942
Practice Address - Country:US
Practice Address - Phone:610-847-1111
Practice Address - Fax:215-278-4051
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA234315MZEMedicare PIN