Provider Demographics
NPI:1265424170
Name:DEALY, HEATHER L (MD)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:DEALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:FOCHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1941 LIMESTONE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5408
Mailing Address - Country:US
Mailing Address - Phone:302-998-2333
Mailing Address - Fax:302-998-3277
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5408
Practice Address - Country:US
Practice Address - Phone:302-998-2333
Practice Address - Fax:302-998-3277
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD42405207W00000X
DEC1-0007303207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100818665-0003Medicaid
PA100818665-0003Medicaid
PA073415Medicare PIN