Basic Information
| Provider Information | |||||||||
| NPI: | 1174503940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEFFNER | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 112 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172677164 | ||||||||
| FaxNumber: | 7172677414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | D68209 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0101233096 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | A102127 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD439330 | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1587829 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 30075072 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 102371056 | 05 | PA | MEDICAID | 2115002 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 301005 | 01 | PA | UNISON-WMG | OTHER | 415765 | 01 | PA | UPMC-WMG | OTHER |