Provider Demographics
NPI:1174521629
Name:HEPNER, BERT CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:BERT
Middle Name:CHARLES
Last Name:HEPNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 1ST AVE
Mailing Address - Street 2:SUITE 275
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2264
Mailing Address - Country:US
Mailing Address - Phone:724-545-2205
Mailing Address - Fax:724-545-2600
Practice Address - Street 1:316 1ST AVE
Practice Address - Street 2:SUITE 275
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2264
Practice Address - Country:US
Practice Address - Phone:724-545-2205
Practice Address - Fax:724-545-2600
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009922L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA311713OtherUPMC
PA001387761OtherHIGHMARK
PA0018882220002Medicaid
PA2013879OtherFIRST HEALTH
PA132388OtherMEDPLUS
PA7788349OtherAETNA
PA1525984OtherGATEWAY
PAH67311Medicare UPIN
PA0018882220002Medicaid