Provider Demographics
NPI:1487127528
Name:HEISER, THOMAS R (PA-C)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:HEISER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26 NESBITT ROAD
Mailing Address - Street 2:SUITE 151
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-3411
Mailing Address - Country:US
Mailing Address - Phone:724-656-0086
Mailing Address - Fax:724-202-6713
Practice Address - Street 1:26 NESBITT ROAD
Practice Address - Street 2:SUITE 151
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3411
Practice Address - Country:US
Practice Address - Phone:724-656-0086
Practice Address - Fax:724-202-6713
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOA004699363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical