Basic Information
| Provider Information | |||||||||
| NPI: | 1558324863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEINE | ||||||||
| FirstName: | LAURICE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 ST PAUL DR STE 207 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176882 | ||||||||
| FaxNumber: | 7172176883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 03/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | MD048664L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 120420413 | 01 | PA | DEPT OF LABOR | OTHER | 50063263 | 01 | PA | CAPITAL BLUECROSS | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 440483 | 01 | PA | HEALTH AMERICA | OTHER | BD3571103 | 01 | PA | DEA | OTHER | G920-0089/KV77CU | 01 | PA | CAREFIRST | OTHER | 1559522 | 01 | PA | GATEWAY | OTHER | 186916 | 01 | PA | UNISON | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 4532284 | 01 | PA | AETNA NON-HMO | OTHER | 770645 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | P00377944 | 01 | PA | RAILROAD MEDICARE | OTHER | 1360595 | 01 | PA | AETNA HMO | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | MD048664L | 01 | PA | LICENSE | OTHER | 001462153 0002 | 05 | PA | MEDICAID | 237267 | 01 | PA | MAMSI | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 25-1716306 | 01 | PA | FIRST HEALTH | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER |